Individual provider Active NPI

Kristin T Okumura, P.T.

  • Physical Therapist
  • Henderson, KY
National Provider Identifier
1710201058
Registry record updated Mar 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
005450 Issued in KY
Practice address
2500 N Elm St
Henderson, KY 42420-2005
Phone
(270) 826-9794
Fax
(270) 826-6265
NPI assigned
Mar 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2010

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 005450 KY Primary

Addresses

Primary practice location

2500 N Elm St
Henderson, KY 42420-2005

Mailing address

2500 N Elm St
Henderson, KY 42420-2005
Phone (270) 826-9794

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180117001636 OR Practitioner - Physical Therapist in Private Practice 2668731712 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clackamas Physical Therapy Associates, Inc.Group PAC ID 1557407012, 6 clinicians

Practice addresses (Care Compare)

11203 SE Sunnyside Rd
Clackamas, OR 97015-7787
Phone (503) 698-5500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
005450KYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Clackamas Physical Therapy Associates, Inc. CurrentSince Oct 23, 2023 Accepting new patients
Premere Rehab LLC Physical Therapist CurrentSince Jan 1, 2018 Accepting new patients
Premere Rehab LLC Physical Therapist CurrentSince Jan 1, 2018 Accepting new patients

Locations

11203 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 698-5500

8100 SW Nyberg St
Ste 200
Tualatin, OR 97062
Phone (503) 570-3365

25117 SW Parkway Ave
Ste D
Wilsonville, OR 97070
Phone (888) 757-3422

Organizations & group practices 3

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": "1268697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268697600000",
    "number": "1710201058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202005",
            "telephone_number": "270-826-9794",
            "fax_number": "270-826-6265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N ELM ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424202005",
            "telephone_number": "270-826-9794",
            "fax_number": "270-826-6265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKUMURA",
        "first_name": "KRISTIN",
        "middle_name": "T",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-16",
        "last_updated": "2010-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "005450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; 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.