Individual provider Active NPI

Michelle Desjarlais Kistler, P.T.

  • Physical Therapist
  • Ashland, OR
National Provider Identifier
1619204450
Registry record updated Nov 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1922 Issued in OR
Practice address
208 Oak St Ste 304
Ashland, OR 97520-1872
Phone
(541) 292-8505
NPI assigned
Nov 16, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2025

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 1922 OR Primary

Addresses

Primary practice location

208 Oak St Ste 304
Ashland, OR 97520-1872

Mailing address

215 Mobile Dr
Ashland, OR 97520-9021
Phone (541) 292-8505

Other practice location 1

208 Oak St Ste 304
Ashland, OR 97520-1872
Phone (541) 292-8505

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100209000563 OR Practitioner - Physical Therapist in Private Practice 1759424054 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

208 Oak St
Suite 304
Ashland, OR 97520-1872
Phone (541) 292-8505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1922ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Oregon Sports & Spine PC CurrentSince Mar 19, 2011 Accepting new patients

Locations

987 Siskiyou Blvd
Ashland, OR 97520
Phone (541) 292-8505

Organizations & group practices 2

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": "1258329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763596800000",
    "number": "1619204450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 MOBILE DR",
            "city": "ASHLAND",
            "state": "OR",
            "postal_code": "975209021",
            "telephone_number": "541-292-8505",
            "fax_number": "541-482-3364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 OAK ST STE 304",
            "city": "ASHLAND",
            "state": "OR",
            "postal_code": "975201872",
            "telephone_number": "541-292-8505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 Oak St Ste 304",
            "address_purpose": "LOCATION",
            "city": "Ashland",
            "state": "OR",
            "postal_code": "975201872",
            "country_code": "US",
            "telephone_number": "541-292-8505",
            "fax_number": "541-552-5282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISTLER",
        "first_name": "MICHELLE",
        "middle_name": "DESJARLAIS",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-16",
        "last_updated": "2025-11-20",
        "certification_date": "2025-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "1922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2025; 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.