Individual provider Active NPI

Katherine A Lyttle, PT

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1477571800
Registry record updated Dec 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5233 Issued in OR
Practice address
1130 NW 22ND Ave Ste 345
Portland, OR 97210-2978
Phone
(503) 413-7513
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 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 5233 OR Primary

Addresses

Primary practice location

1130 NW 22ND Ave Ste 345
Portland, OR 97210-2978

Mailing address

PO Box 3808
Portland, OR 97208-3808
Phone (503) 413-3900

Other practice location 1

2240 N Interstate Ave
Suite 280
Portland, OR 97227-1769
Phone (971) 279-4268

Other names 1

  • Katherine A Stewart Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060920000195 OR Practitioner - Physical Therapist in Private Practice 0446255756 Reassigns benefits to 2 organizations
I20180228000547 WA Practitioner - Physical Therapist in Private Practice 0446255756 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5233ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Emanuel Hospital & Health Center CurrentSince Mar 19, 2007 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Mar 19, 2007 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Sep 1, 2017 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Nov 22, 2017 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Nov 22, 2017 Accepting new patients
Legacy Salmon Creek Hospital CurrentSince Sep 1, 2017 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients

Locations

1130 NW 22nd Ave
Ste 345
Portland, OR 97210
Phone (503) 413-7513

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

Organizations & group practices 8

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513641600000",
    "number": "1477571800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3808",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083808",
            "telephone_number": "503-413-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE STE 345",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102978",
            "telephone_number": "503-413-7513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2240 N Interstate Ave",
            "address_2": "Suite 280",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972271769",
            "country_code": "US",
            "telephone_number": "971-279-4268",
            "fax_number": "971-223-7122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYTTLE",
        "first_name": "KATHERINE",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2017-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "5233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "STEWART",
            "middle_name": "A",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.