Kyle Johnson, DPT
Individual provider Active NPI Physical Therapist · Poplar, WI
NPI 1841963998 · NPPES record last updated Jul 26, 2021
Key facts
- NPI
- 1841963998
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 15548-24 (WI)
- Practice address
- 9675 E Elm Rd
Poplar, WI 54864-9102 - Phone
- (715) 364-8565
- NPI assigned
- Jul 26, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Center for Muscle and Joint Therapy Inc
Practice addresses (Care Compare)
823 Belknap St
Suite 104
Superior, WI 54880-2974
Phone (715) 394-6355
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210902001124 | WI | Practitioner - Physical Therapist in Private Practice | 1052717865 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15548-24 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Muscle & Joint Therapy Inc | Physical Therapist | Current |
Accepting new patients |
Locations
823 Belknap St
Ste 1
Superior, WI 54880
823 Belknap St
Ste 104
Superior, WI 54880
Phone (715) 394-6355
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 15548-24 | WI | Yes |
Addresses
Primary practice location
9675 E Elm Rd
Poplar, WI 54864-9102
Mailing address
1000 Midway Rd
Menasha, WI 54952-1116
Phone (920) 257-2006
Other providers in Poplar, WI
- Eve Bagan
- Jessica Lynn Beckman
- Amy M. Kline
- Kerry L. Lahti
- Northwoods Family Chiropractic
- Orthopedic & Spine Therapy of Poplar, SC
- Orthopedic & Spine Therapy of Poplar, SC
All providers in Poplar, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.