Active NPI
Kenneth Charles Holford
- Physical Therapist
- South Bend, IN
National Provider Identifier
1093456451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 19567 Cleveland Rd
South Bend, IN 46637-3201 - Phone
- (574) 277-7600
- NPI assigned
- Apr 7, 2022
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
19567 Cleveland Rd
South Bend, IN 46637-3201
Mailing address
179 Shorewood Dr
Valparaiso, IN 46385-7710
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649289600000",
"number": "1093456451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "179 SHOREWOOD DR",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463857710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19567 CLEVELAND RD",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466373201",
"telephone_number": "574-277-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLFORD",
"first_name": "KENNETH",
"middle_name": "CHARLES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-07",
"last_updated": "2022-04-07",
"certification_date": "2022-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.