Casey Ketelsen, DPT – Physical Therapist

Key facts

NPI: 1093971152
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: 070016508 (IL)
Practice address: 2900 N US Highway 12 Ste J
Spring Grove, IL 60081-8322
Phone: (815) 675-0699
Fax: (815) 675-0689
NPI assigned: Jul 29, 2008
Sex: Male
Sole proprietor: No

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.

Back in Motion Physical Therapy & Spine Center PC Physical Therapist · Spring Grove, IL · NPI 1972727360

NPD (past) PHYSICAL THERAPIST

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Back in Motion Physical Therapy & Spine Center PC	Physical Therapist	Past since Jul 30, 2004	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	070016508	IL	Yes

Addresses

Primary practice location

2900 N US Highway 12 Ste J
Spring Grove, IL 60081-8322

Mailing address

PO Box 362
2900 US Highway 12 Suite J
Spring Grove, IL 60081-0362
Phone (815) 675-0699

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 29, 2008.

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217289600000",
    "number": "1093971152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 362",
            "address_2": "2900 US HIGHWAY 12 SUITE J",
            "city": "SPRING GROVE",
            "state": "IL",
            "postal_code": "600810362",
            "telephone_number": "815-675-0699",
            "fax_number": "815-675-0689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 N US HIGHWAY 12 STE J",
            "city": "SPRING GROVE",
            "state": "IL",
            "postal_code": "600818322",
            "telephone_number": "815-675-0699",
            "fax_number": "815-675-0689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETELSEN",
        "first_name": "CASEY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-29",
        "last_updated": "2008-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070016508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Grove, IL

All providers in Spring Grove, IL · Physical Therapist in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.