Individual provider Active NPI

Alyssa Kienitz

  • Physical Therapist
  • Duluth, MN
National Provider Identifier
1619306255
Registry record updated Dec 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9303 Issued in MN
Practice address
530 E 2ND St
Duluth, MN 55805-1913
Phone
(218) 786-5360
NPI assigned
Nov 4, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2018

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 9303 MN Primary

Addresses

Primary practice location

530 E 2ND St
Duluth, MN 55805-1913

Mailing address

447 Marshall Ave Apt 2
Saint Paul, MN 55102-1766

Other names 1

  • Alyssa Baltes Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250313003893 MN Practitioner - Physical Therapist in Private Practice 5496286056 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9303MNMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD CurrentSince Jan 9, 2025 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Jan 9, 2025 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

1600 Miller Trunk Hwy
Ste 1300
Duluth, MN 55811
Phone (218) 786-3392

530 E 2nd St
Duluth, MN 55805
Phone (218) 786-5300

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

Organizations & group practices 4

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": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543881600000",
    "number": "1619306255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 MARSHALL AVE APT 2",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551021766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051913",
            "telephone_number": "218-786-5360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIENITZ",
        "first_name": "ALYSSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-04",
        "last_updated": "2018-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "9303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "BALTES",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.