Active NPI
Kelly Klika
- Physical Therapist
- Appleton, WI
National Provider Identifier
1194978775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11088-024
- Practice address
- 1506 S Oneida St
Appleton, WI 54915-1305 - Phone
- (920) 738-2079
- NPI assigned
- Oct 28, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11088-024 | WI | Primary |
Addresses
Primary practice location
1506 S Oneida St
Appleton, WI 54915-1305
Mailing address
1570 Midway PL
Menasha, WI 54952-1165
Phone (920) 720-1464
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36187500 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11088-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1194978775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1570 MIDWAY PL",
"city": "MENASHA",
"state": "WI",
"postal_code": "549521165",
"telephone_number": "920-720-1464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1506 S ONEIDA ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549151305",
"telephone_number": "920-738-2079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLIKA",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "11088-024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36187500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.