Active NPI
Kelly J Malmquist, PTA
- Physical Therapy Assistant
- Green Bay, WI
National Provider Identifier
1609922665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1321019
- Practice address
- 1040 Pilgrim Way
Green Bay, WI 54304-5028 - Phone
- (920) 405-3522
- Fax
- (920) 405-3523
- NPI assigned
- Jan 25, 2007
- 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 Therapy Assistant | 225200000X | 1321019 | WI | Primary |
Addresses
Primary practice location
1040 Pilgrim Way
Green Bay, WI 54304-5028
Mailing address
360 Mark Court
Neenah, WI 54956
Phone (920) 209-0915
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36120300 | Medicaid | WI |
Other names 1
- Kelly Jean Zahl
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 |
|---|---|---|---|
| 1321019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335139200000",
"number": "1609922665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 MARK COURT",
"city": "NEENAH",
"state": "WI",
"postal_code": "54956",
"telephone_number": "920-209-0915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 PILGRIM WAY",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543045028",
"telephone_number": "920-405-3522",
"fax_number": "920-405-3523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALMQUIST",
"first_name": "KELLY",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-25",
"last_updated": "2012-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "1321019",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36120300",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "ZAHL",
"middle_name": "JEAN",
"code": "5",
"type": "Other Name"
}
]
}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 Apr 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.