Individual provider Active NPI

Kalen Jolk, DPT

  • Physical Therapist
  • Maple Valley, WA
National Provider Identifier
1477987246
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60379524 Issued in WA
Practice address
24060 SE Kent Kangley Rd
Suite D100
Maple Valley, WA 98038-6801
Phone
(425) 433-0123
Fax
(425) 433-0733
NPI assigned
Aug 28, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

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 PT60379524 WA Primary

Addresses

Primary practice location

24060 SE Kent Kangley Rd
Suite D100
Maple Valley, WA 98038-6801

Mailing address

24060 SE Kent Kangley Rd
Suite D100
Maple Valley, WA 98038-6801
Phone (425) 433-0123

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131118000305 WA Practitioner - Physical Therapist in Private Practice 2466688635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Medical Group-RentonGroup PAC ID 4183753965, 419 clinicians

Practice addresses (Care Compare)

16850 SE 272ND St
Covington, WA 98042-4931

24060 SE Kent Kangley Rd
Suite D100
Maple Valley, WA 98038-6801
Phone (425) 433-0123

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT60379524WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Medical Group-Renton CurrentSince Jan 1, 2019 Accepting new patients
Pinnacle Therapy Group Physical Therapist CurrentSince Sep 16, 2013 Accepting new patients
Public Hospital District #1 of King County Past Accepting new patients

Locations

16850 SE 272nd St
Ste 100
Covington, WA 98042
Phone (253) 395-1971

24060 SE Kent Kangley Rd
#D100
Maple Valley, WA 98038
Phone (425) 358-7708

Organizations & group practices 3

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": "1377648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377648000000",
    "number": "1477987246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24060 SE KENT KANGLEY RD",
            "address_2": "SUITE D100",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980386801",
            "telephone_number": "425-433-0123",
            "fax_number": "425-433-0733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24060 SE KENT KANGLEY RD",
            "address_2": "SUITE D100",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980386801",
            "telephone_number": "425-433-0123",
            "fax_number": "425-433-0733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLK",
        "first_name": "KALEN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-28",
        "last_updated": "2013-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60379524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2013; 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.