Active NPI
Kyle Joseph Wirkus, D-PT
- Physical Therapist
- Seymour, WI
National Provider Identifier
1689313066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 15800-24
- Practice address
- 405 Commercial St
Seymour, WI 54165-8474 - Phone
- (920) 833-2318
- Fax
- (920) 833-6883
- NPI assigned
- Jun 2, 2022
- 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 | 15800-24 | WI | Primary |
Addresses
Primary practice location
405 Commercial St
Seymour, WI 54165-8474
Mailing address
PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222
Other practice location 1
107 E Highland Dr
Oconto Falls, WI 54154-1002
Phone (920) 846-3092
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220627003273 | WI | Practitioner - Physical Therapist in Private Practice | 6507245206 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15800-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658102400000",
"number": "1689313066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22487",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543052487",
"telephone_number": "920-445-7222",
"fax_number": "920-445-7289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 COMMERCIAL ST",
"city": "SEYMOUR",
"state": "WI",
"postal_code": "541658474",
"telephone_number": "920-833-2318",
"fax_number": "920-833-6883"
}
],
"practiceLocations": [
{
"address_1": "107 E Highland Dr",
"address_purpose": "LOCATION",
"city": "Oconto Falls",
"state": "WI",
"postal_code": "541541002",
"country_code": "US",
"telephone_number": "920-846-3092",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WIRKUS",
"first_name": "KYLE",
"middle_name": "JOSEPH",
"credential": "D-PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-02",
"last_updated": "2022-07-18",
"certification_date": "2022-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "15800-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seymour, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.