Individual provider Active NPI

Katelyn Oldziejewski

  • Physical Therapy Assistant
  • Ketchikan, AK
National Provider Identifier
1861358830
Registry record updated Jan 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
CP051717A Issued in AK
Practice address
4079 Tongass Ave Ste 102
Ketchikan, AK 99901-5559
Phone
(907) 308-6077
NPI assigned
Jan 2, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X CP051717A AK Primary

Addresses

Primary practice location

4079 Tongass Ave Ste 102
Ketchikan, AK 99901-5559

Mailing address

178 Honey Jar Way
Longs, SC 29568-9054
Phone (570) 899-0702

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

LicenseStateTypeSpecialty
CP051717AAKMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1767312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767312000000",
    "number": "1861358830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 HONEY JAR WAY",
            "city": "LONGS",
            "state": "SC",
            "postal_code": "295689054",
            "telephone_number": "570-899-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4079 TONGASS AVE STE 102",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015559",
            "telephone_number": "907-308-6077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDZIEJEWSKI",
        "first_name": "KATELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-01-02",
        "last_updated": "2026-01-02",
        "certification_date": "2026-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AK",
            "license": "CP051717A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ketchikan, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2026; 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.