KELLIE T WILSON (MPT) – Specialist, NPI 1306982384
Specialist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,808 PHYSICAL THERAPIST IN PRIVATE PRACTICE in OR
Provider Addresses for KELLIE T WILSON (MPT)
18122 SW LOWER BOONES FERRY RD
TIGARD, OR 972247216
Phone: (503) 639-2118
Fax: (503) 639-7688
Type: Mailing
330 NE MARSHALL AVE
BEND, OR 977014346
Phone: (541) 383-8179
Fax: (541) 685-2639
Type: Mailing
2115 NE WYATT CT STE 103
BEND, OR 977017679
Phone: (541) 382-2070
Fax: (541) 685-2639
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2008-09-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20080908000210 | I | Physical Therapist In Private Practice | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97530 | Therapy procedure using functional activities | 1,494 | 65 | $0 |
| 97140 | Therapy procedure using manual technique, each 15 minutes | 640 | 61 | $0 |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 92 | 11 | $0 |
| 97162 | Evaluation for physical therapy, typically 30 minutes | 49 | 43 | $0 |
Insurance plans in this area (ZIP 97224)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICAL THERAPY | OR | 97140 | Manual (physical) therapy techniques to 1 or more regions, each 15 minutes | 245 | 29 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | OR | |
| Physical Therapist In Private Practice | CA | |
| Physical Therapist In Private Practice | OR | |
| Physical Therapist In Private Practice | CO | |
| Physical Therapist In Private Practice | OR | |
| Physical Therapist In Private Practice | OR | |
| Physical Therapist In Private Practice | OR | |
| - | OR | |
| Physical Therapist In Private Practice | OR | |
| Physical Therapist In Private Practice | CA |
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