Kellie T Wilson, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

2115 NE Wyatt CT Ste 103
Bend, OR 97701-7679

Phone

(541) 382-2070

Fax

(541) 685-2639

NPI assigned

Jan 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physical Therapy Works, IncGroup PAC ID 0345289757, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Physical Therapy Works, Inc

  • Physical Therapist
  • Bend, OR
  • NPI 1104041185
  Medicare reassignment Care Compare group NPD
• Physical Therapy Works, Inc

  • Physical Therapist
  • Redmond, OR
  • NPI 1740031285
  NPD
• Gateway Sports Medicine & Rehabilitation PC

  • Physical Therapist
  • Portland, OR
  • NPI 1972698892
  NPD (past)
• New Proactive LLC

  • Physical Therapy Clinic/Center
  • Oregon City, OR
  • NPI 1396273199

  Physical Therapist

  NPD (past)
• Proactive Orthopedic and Sports Physical Therapy of Oregon City LLC

  • Physical Therapy Clinic/Center
  • Oregon City, OR
  • NPI 1760443477
  NPD (past)
• Walton Physical Therapy & Sports Medicine Inc

  • Rehabilitation Clinic/Center
  • Durham, OR
  • NPI 1871717611

  Physical Therapist

  NPD (past)
• Proactive Orthopedic and Sports Physical Therapy of East Vancouver LLC

  • Physical Therapy Clinic/Center
  • Vancouver, WA
  • NPI 1053326561
  NPD (past)
• Proactive Orthopedic and Sports Physical Therapy of Vancouver, LLC

  • Physical Therapy Clinic/Center
  • Vancouver, WA
  • NPI 1235190950
  NPD (past)

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644883200000",
    "number": "1306982384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 NE MARSHALL AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014346",
            "telephone_number": "541-383-8179",
            "fax_number": "541-685-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 NE WYATT CT STE 103",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977017679",
            "telephone_number": "541-382-2070",
            "fax_number": "541-685-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELLIE",
        "middle_name": "T",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF OREGON LICENSE NUMBER",
            "identifier": "3074",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207626",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Wilson, MA
• Jaron Wilson, ATC
• Jennifer Wilson
• John Bryan Wilson, QHMP
• Joshua Seth Wilson
• Rachael Dorothy Wilson
• Renee Michele Wilson, OTR/L
• Sabrina Sue Wilson, QMHA
• Tracy Maloney Wilson, D.O.
• William Thomas Wilson, LPC

• Physical Therapist in Bend, OR
• Providers in Bend, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; 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.