Active NPI
Patrick Kinney, PT
- Physical Therapist
- Wausau, WI
National Provider Identifier
1609983964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2942
- Practice address
- 3605 Stewart Ave
Ste 200
Wausau, WI 54401-4938 - Phone
- (715) 847-3796
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- 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 | 2942 | WI | Primary |
Addresses
Primary practice location
3605 Stewart Ave
Ste 200
Wausau, WI 54401-4938
Mailing address
1000 N Oak Ave
Marshfield, WI 54449-5777
Phone (715) 387-5511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40108300 | 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2942 | WI | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251849600000",
"number": "1609983964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 N OAK AVE",
"city": "MARSHFIELD",
"state": "WI",
"postal_code": "544495777",
"telephone_number": "715-387-5511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3605 STEWART AVE",
"address_2": "STE 200",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014938",
"telephone_number": "715-847-3796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNEY",
"first_name": "PATRICK",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2009-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "2942",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40108300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.