Individual provider Active NPI

John Kellerstrass, PT, ATC, MED

  • Physical Therapist
  • Centerville, OH
National Provider Identifier
1043287915
Registry record updated Jul 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-OH9128 Issued in OH
Practice address
1553 Lyons Rd
Centerville, OH 45458-1881
Phone
(937) 438-0647
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-OH9128 OH Primary

Addresses

Primary practice location

1553 Lyons Rd
Centerville, OH 45458-1881

Mailing address

1238 Chaucer PL
Maineville, OH 45039-9750
Phone (513) 314-1487

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041216001134 OH Practitioner - Physical Therapist in Private Practice 0042129132 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
PT-OH9128OHMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rehabclinics SPT Inc Physical Therapist CurrentSince Oct 23, 2020 Accepting new patients
Rehabclinics SPT, Inc. CurrentSince Oct 23, 2020 Accepting new patients
Orthopedic Associates of Shelby County Inc Past Accepting new patients
Novacare Rehabilitation of Ohio Inc Past Accepting new patients
Freiberg Orthopaedics & Sports Medicine Past Accepting new patients

Locations

9596 Colerain Ave
Cincinnati, OH 45251
Phone (513) 661-3114

5999 Meijer Dr
Milford, OH 45150
Phone (513) 226-8712

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437436800000",
    "number": "1043287915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1238 CHAUCER PL",
            "city": "MAINEVILLE",
            "state": "OH",
            "postal_code": "450399750",
            "telephone_number": "513-314-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1553 LYONS RD",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454581881",
            "telephone_number": "937-438-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLERSTRASS",
        "first_name": "JOHN",
        "credential": "PT, ATC, MED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2015-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT-OH9128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centerville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.