Active NPI
Kyle McKibben
- Physical Therapist
- Germantown, WI
National Provider Identifier
1245844711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 15103-24
- Practice address
- W173N10915 Bernies Way
Germantown, WI 53022-4043 - Phone
- (262) 509-3300
- NPI assigned
- Sep 2, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 15103-24 | WI | Primary |
Addresses
Primary practice location
W173N10915 Bernies Way
Germantown, WI 53022-4043
Mailing address
924 E Juneau Ave Apt 817
Milwaukee, WI 53202-2748
Phone (513) 324-4122
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599004800000",
"number": "1245844711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "924 E JUNEAU AVE APT 817",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532022748",
"telephone_number": "513-324-4122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W173N10915 BERNIES WAY",
"city": "GERMANTOWN",
"state": "WI",
"postal_code": "530224043",
"telephone_number": "262-509-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKIBBEN",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-02",
"last_updated": "2020-09-02",
"certification_date": "2020-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "15103-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.