Individual provider Active NPI

Kenneth D Keesee Jr., DPT

  • Physical Therapist
  • Goldsboro, NC
National Provider Identifier
1043476765
Registry record updated Aug 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P11668 Issued in NC
Practice address
2503 Wayne Memorial Dr
Goldsboro, NC 27534-9401
Phone
(919) 734-1311
Fax
(919) 734-8816
NPI assigned
Aug 1, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2008

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 P11668 NC Primary

Addresses

Primary practice location

2503 Wayne Memorial Dr
Goldsboro, NC 27534-9401

Mailing address

2503 Wayne Memorial Dr
Goldsboro, NC 27534-9401
Phone (919) 734-1311

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080924000155 NC Practitioner - Physical Therapist in Private Practice 5890862494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Goldsboro Physical Therapy and WellnessGroup PAC ID 8022287804, 7 clinicians

Practice addresses (Care Compare)

2503 Wayne Memorial Dr
Goldsboro, NC 27534-9401
Phone (919) 734-1311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11668NCMDPharmacist
P11668NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Goldsboro Physical Therapy & Wellness Physical Therapist CurrentSince Jun 15, 2011 Accepting new patients

Locations

2503 Wayne Memorial Dr
Goldsboro, NC 27534
Phone (919) 734-1311

Organizations & group practices 1

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": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217548800000",
    "number": "1043476765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2503 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349401",
            "telephone_number": "919-734-1311",
            "fax_number": "919-734-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2503 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349401",
            "telephone_number": "919-734-1311",
            "fax_number": "919-734-8816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEESEE",
        "first_name": "KENNETH",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2008-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P11668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; 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.