Active NPI
Kelcie Wittman
- Physical Therapist
- Madison, WI
National Provider Identifier
1699199604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12614-24
- Practice address
- 4602 Eastpark Blvd
Madison, WI 53718-2002 - Phone
- (608) 440-6444
- NPI assigned
- Feb 11, 2014
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 005326 | IA | |
| Physical Therapist | 225100000X | 070-020518 | IL | |
| Physical Therapist | 225100000X | 12614-24 | WI | Primary |
Addresses
Primary practice location
4602 Eastpark Blvd
Madison, WI 53718-2002
Mailing address
4602 Eastpark Blvd
Madison, WI 53718-2002
Phone (608) 440-6444
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 |
|---|---|---|---|
| 005326 | IA | MD | Physical Therapist |
| 070-020518 | IL | MD | Physical Therapist |
| 12614-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449705600000",
"number": "1699199604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4602 EASTPARK BLVD",
"city": "MADISON",
"state": "WI",
"postal_code": "537182002",
"telephone_number": "608-440-6444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4602 EASTPARK BLVD",
"city": "MADISON",
"state": "WI",
"postal_code": "537182002",
"telephone_number": "608-440-6444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTMAN",
"first_name": "KELCIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-11",
"last_updated": "2015-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IA",
"license": "005326",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070-020518",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "12614-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.