Active NPI
Karissa Ann Poppen, PT
- Orthopedic Physical Therapist
- Pontiac, IL
National Provider Identifier
1346708435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 070.023947
- Practice address
- 2500 W Reynolds St
Pontiac, IL 61764-9774 - Phone
- (815) 842-2828
- Fax
- (815) 842-4912
- NPI assigned
- Mar 7, 2019
- Last updated
- Mar 16, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 070.023947 | IL | Primary |
Addresses
Primary practice location
2500 W Reynolds St
Pontiac, IL 61764-9774
Mailing address
17 Jasper Dr
Morton, IL 61550-1127
Phone (309) 229-4754
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.023947 | IL | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647388800000",
"number": "1346708435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 JASPER DR",
"city": "MORTON",
"state": "IL",
"postal_code": "615501127",
"telephone_number": "309-229-4754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 W REYNOLDS ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617649774",
"telephone_number": "815-842-2828",
"fax_number": "815-842-4912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POPPEN",
"first_name": "KARISSA",
"middle_name": "ANN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-07",
"last_updated": "2022-03-16",
"certification_date": "2022-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "IL",
"license": "070.023947",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, IL
- Pontiac CC School Dist 429
- Pontiac Family Eye Care LLC
- Pontiac Healthcare and Rehab,LLC
- Pontiac Supportive Living, LLC (Pointe at Pontiac)
- Pontiac TWP HS Dist 90
- Positive Direction Counseling, PC
- Premier Medical Group, LLC (Scott O'Connor, DPM)
- Pro Podiatry, LLC (Premier Podiatry)
- Gloria Ann Przygoda, DNP, FNP-BC
- John C Purnell, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.