Individual provider Active NPI

Kip Stromberg, PT

  • Physical Therapist
  • Tacoma, WA
National Provider Identifier
1285153379
Registry record updated Sep 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60775144 Issued in WA
Practice address
15703 Pacific Ave S Ste B
Tacoma, WA 98444-4675
Phone
(253) 531-4100
Fax
(253) 531-3795
NPI assigned
Sep 11, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60775144 WA Primary

Addresses

Primary practice location

15703 Pacific Ave S Ste B
Tacoma, WA 98444-4675

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210910000287 ID Practitioner - Physical Therapist in Private Practice 4385919182 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of North Carolina at Chapel Hill School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Current Physical Therapy Weiser LLCGroup PAC ID 1951791136, 3 clinicians

Practice addresses (Care Compare)

770 E
1St Suite B
Weiser, ID 83672-2304
Phone (208) 718-0827

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT60775144WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Current Physical Therapy Weiser LLC Physical Therapist CurrentSince Nov 3, 2021 Accepting new patients
Current Physical Therapy LLC Physical Therapist CurrentSince Aug 1, 2021 Accepting new patients

Locations

2175 N Whitley Dr
Fruitland, ID 83619
Phone (208) 452-0303

770 E 1st St
#B
Weiser, ID 83672
Phone (208) 718-0827

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505088000000",
    "number": "1285153379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15703 PACIFIC AVE S STE B",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984444675",
            "telephone_number": "253-531-4100",
            "fax_number": "253-531-3795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STROMBERG",
        "first_name": "KIP",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-11",
        "last_updated": "2017-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60775144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.