Ilana Nicole Kellogg Waasdorp, PT, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

2305212941 Issued in VA

Practice address

1421 3Rd St SW
Roanoke, VA 24016-5204

Phone

(303) 900-3457

NPI assigned

Jun 3, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1720425549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 3RD ST SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240165204",
            "telephone_number": "303-900-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 3RD ST SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240165204",
            "telephone_number": "303-900-3457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAASDORP",
        "first_name": "ILANA",
        "middle_name": "NICOLE KELLOGG",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-03",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0012174",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "VA",
            "license": "2305212941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chiraag Vyas, MD
• W. Hampton Pasley, M.D., PLC (Pasley Surgical)
• W. Robert Wisman MD PC
• Barryton Decruse Waanbah, M.D.
• Christopher Paul Waasdorp Jr., D.O.
• Kayla Wade, CRNA
• Lisa Wade, MS, CCC/SLP
• Julia Wadolowska, PA
• Raniyah Majied Wagher
• Donna Wagner, L.P.C.

• Pediatric Physical Therapist in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Pediatric Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.