Active NPI
Carly Jo Coulthart, PT
- Physical Therapist
- Green Bay, WI
National Provider Identifier
1386532703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17244-24
- Practice address
- 1110 Kepler Dr
Green Bay, WI 54311-8306 - Phone
- (920) 932-6050
- NPI assigned
- Jun 25, 2025
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 17244-24 | WI | Primary |
Addresses
Primary practice location
1110 Kepler Dr
Green Bay, WI 54311-8306
Mailing address
PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100333301 | Medicaid | WI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/ | ||
| Direct Messaging Address | ccoulthart428568@direct.myadvocateaurora.org | Direct |
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 |
|---|---|---|---|
| 17244-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758153600000",
"number": "1386532703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 735044",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606735044",
"telephone_number": "800-326-2250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 KEPLER DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543118306",
"telephone_number": "920-932-6050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COULTHART",
"first_name": "CARLY",
"middle_name": "JO",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-25",
"last_updated": "2025-09-18",
"certification_date": "2025-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "17244-24",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100333301",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
"affiliation": "N",
"address_1": "1110 Kepler Dr",
"city": "Green Bay",
"state": "WI",
"country_code": "US",
"postal_code": "543118306",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ccoulthart428568@direct.myadvocateaurora.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1110 Kepler Dr",
"city": "Green Bay",
"state": "WI",
"country_code": "US",
"postal_code": "543118306",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.