Active NPI
Theresa Muldoon Kimball, MPT
- Physical Therapist
- Springfield, OR
National Provider Identifier
1871592022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1987
- Practice address
- 1236 Janus St
Springfield, OR 97477-3592 - Phone
- (541) 747-1415
- Fax
- (541) 747-1415
- NPI assigned
- Jul 19, 2005
- Sex
- Female
- Sole proprietor
- No
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 | 1987 | OR | Primary |
Addresses
Primary practice location
1236 Janus St
Springfield, OR 97477-3592
Mailing address
1236 Janus St
Springfield, OR 97477-3592
Phone (541) 747-1415
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070105000035 | OR | Practitioner - Physical Therapist in Private Practice | 8325048945 | Practice locations: Springfield, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1236 Janus St
Springfield, OR 97477-3592
Phone (541) 653-6332
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1987 | OR | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871592022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1236 JANUS ST",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974773592",
"telephone_number": "541-747-1415",
"fax_number": "541-747-1415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1236 JANUS ST",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974773592",
"telephone_number": "541-747-1415",
"fax_number": "541-747-1415"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "THERESA",
"middle_name": "MULDOON",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "1987",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.