Active NPI
Camilla Lynn Kohutko, PT
- Physical Therapist
- Wabasha, MN
National Provider Identifier
1508010158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6099
- Practice address
- 1200 Grant Blvd W
Wabasha, MN 55981-1042 - Phone
- (651) 565-5558
- Fax
- (651) 565-5627
- NPI assigned
- Nov 10, 2008
- Last updated
- Dec 5, 2008
- 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 | 6099 | MN | Primary |
Addresses
Primary practice location
1200 Grant Blvd W
Wabasha, MN 55981-1042
Mailing address
1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-5558
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11004000 | Medicaid | WI |
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 |
|---|---|---|---|
| 6099 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228435200000",
"number": "1508010158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 GRANT BLVD W",
"city": "WABASHA",
"state": "MN",
"postal_code": "559811042",
"telephone_number": "651-565-5558",
"fax_number": "651-565-5627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 GRANT BLVD W",
"city": "WABASHA",
"state": "MN",
"postal_code": "559811042",
"telephone_number": "651-565-5558",
"fax_number": "651-565-5627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOHUTKO",
"first_name": "CAMILLA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-10",
"last_updated": "2008-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "6099",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11004000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wabasha, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.