Active NPI
Kathleen Michelle Ellis, PT
- Physical Therapist
- Cobleskill, NY
National Provider Identifier
1003036070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 021255-1
- Practice address
- 178 Grandview Dr
Cobleskill, NY 12043-5144 - Phone
- (518) 254-3261
- Fax
- (518) 254-3335
- NPI assigned
- May 1, 2007
- 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 | 021255-1 | NY | Primary |
Addresses
Primary practice location
178 Grandview Dr
Cobleskill, NY 12043-5144
Mailing address
372 N Grand St
Cobleskill, NY 12043-4139
Phone (518) 234-9622
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
| License | State | Type | Specialty |
|---|---|---|---|
| 021255-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003036070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "372 N GRAND ST",
"city": "COBLESKILL",
"state": "NY",
"postal_code": "120434139",
"telephone_number": "518-234-9622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "178 GRANDVIEW DR",
"city": "COBLESKILL",
"state": "NY",
"postal_code": "120435144",
"telephone_number": "518-254-3261",
"fax_number": "518-254-3335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "KATHLEEN",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "021255-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cobleskill, NY
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.