Individual provider Active NPI

Katelyn Halicks, DPT

  • Physical Therapist
  • Tacoma, WA
National Provider Identifier
1750758280
Registry record updated Sep 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60572443 Issued in WA
Practice address
1901 S 72ND St
Suite a-1
Tacoma, WA 98408-1200
Phone
(253) 475-4870
Fax
(253) 475-4873
NPI assigned
Sep 1, 2015
Last updated
Sep 1, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2015

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 PT60572443 WA Primary

Addresses

Primary practice location

1901 S 72ND St
Suite a-1
Tacoma, WA 98408-1200

Mailing address

9315 Gravelly Lake Dr SW
Suite 306
Lakewood, WA 98499-1574
Phone (253) 581-5200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150917000787 WA Practitioner - Physical Therapist in Private Practice 6002123494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

6704 Tacoma Mall Blvd
Suite 100
Tacoma, WA 98409-9001
Phone (253) 475-4870

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Mar 5, 2018 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System CurrentSince Mar 5, 2018 Accepting new patients
Olympic Sports and Spine Rehabilitation, P.S. Physical Therapist Past Accepting new patients

Locations

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

8011 112th Street Ct E
Puyallup, WA 98373
Phone (253) 848-0662

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

7727 40th St W
Ste A
University Place, WA 98466
Phone (253) 460-1362

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441065600000",
    "number": "1750758280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9315 GRAVELLY LAKE DR SW",
            "address_2": "SUITE 306",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991574",
            "telephone_number": "253-581-5200",
            "fax_number": "253-581-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S 72ND ST",
            "address_2": "SUITE A-1",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984081200",
            "telephone_number": "253-475-4870",
            "fax_number": "253-475-4873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALICKS",
        "first_name": "KATELYN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60572443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.