Active NPI
Kimberly A Wateska, MPT
- Physical Therapist
- Bloomington, IN
National Provider Identifier
1841547148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05008103A
- Practice address
- 3211 E Moores Pike
Bloomington, IN 47401-7129 - Phone
- (812) 334-7604
- Fax
- (812) 334-7705
- NPI assigned
- Aug 7, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05008103A | PA | Primary |
Addresses
Primary practice location
3211 E Moores Pike
Bloomington, IN 47401-7129
Mailing address
2436 E Canada Dr
Bloomington, IN 47401
Phone (812) 334-3010
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 |
|---|---|---|---|
| 05008103A | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345161600000",
"number": "1841547148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2436 E CANADA DR",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "47401",
"telephone_number": "812-334-3010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3211 E MOORES PIKE",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474017129",
"telephone_number": "812-334-7604",
"fax_number": "812-334-7705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATESKA",
"first_name": "KIMBERLY",
"middle_name": "A",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-07",
"last_updated": "2012-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "05008103A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.