NPIMap

Individual provider Active NPI

Teryn Wiens, PT, DPT

  • Physical Therapist
  • Prineville, OR
National Provider Identifier
1720484371
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
60781 Issued in OR
Practice address
1590 NE 3Rd St Ste B
Prineville, OR 97754-2916
Phone
(541) 416-7476
Fax
(541) 416-7478
NPI assigned
Nov 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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 60781 OR Primary

Addresses

Primary practice location

1590 NE 3Rd St Ste B
Prineville, OR 97754-2916

Mailing address

805 SW Industrial Way Ste 3
Bend, OR 97702-1093
Phone (541) 416-7476

Other practice location 1

911 Main St Ste 150
Oregon City, OR 97045-1868
Phone (503) 655-4877

Other identifiers 1

IdentifierTypeStateIssuer
500679012MedicaidOR

Other names 1

  • Teryn Kaldheim Former name

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

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": "1415577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1720484371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 SW INDUSTRIAL WAY STE 3",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021093",
            "telephone_number": "541-416-7476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1590 NE 3RD ST STE B",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542916",
            "telephone_number": "541-416-7476",
            "fax_number": "541-416-7478"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "911 Main St Ste 150",
            "address_purpose": "LOCATION",
            "city": "Oregon City",
            "state": "OR",
            "postal_code": "970451868",
            "country_code": "US",
            "telephone_number": "503-655-4877",
            "fax_number": "503-655-4795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIENS",
        "first_name": "TERYN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-10",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "60781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500679012",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERYN",
            "last_name": "KALDHEIM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Prineville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.