Kylie Bollweg

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2022028646 Issued in MO

Practice address

1839 E Independence St Ste R
Springfield, MO 65804-3753

Phone

(316) 260-3311

NPI assigned

Sep 7, 2022

Last updated

Sep 7, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physical Therapy by Phoenix of Springfield LLCGroup PAC ID 9931513645, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Physical Therapy by Phoenix of Springfield LLC

  dba Physical Therapy by Phoenix

  • Physical Therapy Clinic/Center
  • Springfield, MO
  • NPI 1831785559

  Physical Therapist

  NPD

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1891416822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12627 E CENTRAL AVE STE 308",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672062839",
            "telephone_number": "316-260-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 E INDEPENDENCE ST STE R",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658043753",
            "telephone_number": "316-260-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLWEG",
        "first_name": "KYLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2022028646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blaik Bolerjack
• Anthony C Bolin II, DC
• Katherine A Bollar, MS, LPC
• Donna Sue Bollinger, RD
• Salina Bollinger, LCSW
• Barbara D Bolton, LCSW
• Kelsey M Bolton, MA, LPC
• Bennett Adam Bolyard, D.O.
• Heidi Bond
• Russell R. Bond Jr., D.O.

• Physical Therapist in Springfield, MO
• Providers in Springfield, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.