Kathleen Marie Walesewicz, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3584 - 024 Issued in WI

Practice address

1310 E Cloverland Dr
Ironwood, MI 49938-1606

Phone

(906) 932-4200

Fax

(906) 932-4201

NPI assigned

Apr 10, 2008

Last updated

Sep 28, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348790400000",
    "number": "1275706137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 E CLOVERLAND DR",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499381606",
            "telephone_number": "906-932-4200",
            "fax_number": "906-932-4201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 E CLOVERLAND DR",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499381606",
            "telephone_number": "906-932-4200",
            "fax_number": "906-932-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALESEWICZ",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-10",
        "last_updated": "2012-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3584 - 024",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501005312",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40229400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dylynn M Vanderschaegen, RPH
• Franklin A Villanueva, MD
• Lowell Vomhof, CRNA
• Wal-Mart Stores East LP (Walmart Pharmacy 10-5444)
• Wal-Mart Stores East, LP (Vision Center 30-5444)
• Walgreen Co (Walgreens # 11954)
• Lori Lynne Wallace, LPN, RCS
• Russell Willson
• David S Wood, DPM
• Robyn Jane Woodruff, MFTC

• Physical Therapist in Ironwood, MI
• Providers in Ironwood, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.