Individual provider Active NPI

Kennady Marie Miller, DPT

  • Physical Therapist
  • Millersburg, OH
National Provider Identifier
1053057414
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT019747 Issued in OH
Practice address
1207 S Washington St
Millersburg, OH 44654-9497
Phone
(330) 600-0844
NPI assigned
May 9, 2022
Last updated
May 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

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 PT019747 OH Primary

Addresses

Primary practice location

1207 S Washington St
Millersburg, OH 44654-9497

Mailing address

1207 S Washington St
Millersburg, OH 44654-9497
Phone (330) 600-0844

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230425001028 OH Practitioner - Physical Therapist in Private Practice 1052776168 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promotion Therapy Inc.Group PAC ID 3678728748, 3 clinicians

Practice addresses (Care Compare)

1207 S Washington St
Millersburg, OH 44654-9497
Phone (330) 600-0844

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Promotion Therapy Inc. CurrentSince Jan 1, 2023 Accepting new patients

Locations

1207 S Washington St
Millersburg, OH 44654
Phone (330) 600-0841

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1652054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652054400000",
    "number": "1053057414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 S WASHINGTON ST",
            "city": "MILLERSBURG",
            "state": "OH",
            "postal_code": "446549497",
            "telephone_number": "330-600-0844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 S WASHINGTON ST",
            "city": "MILLERSBURG",
            "state": "OH",
            "postal_code": "446549497",
            "telephone_number": "330-600-0844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "KENNADY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-09",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT019747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millersburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.