Ethan Kicker

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTH10221 Issued in AL

Practice address

3569 Pelham Pkwy Ste 7
Pelham, AL 35124-2033

Phone

(205) 664-8404

NPI assigned

Feb 4, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Therapy South - AlabasterGroup PAC ID 4688101918, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95 of 100Reported as individual

Quality

90

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Therapy South - Alabaster

  • Physical Therapist
  • Alabaster, AL
  • NPI 1568291664
  Medicare reassignment Care Compare group NPD
• Therapy South Pelham, LLC

  • Physical Therapist
  • Pelham, AL
  • NPI 1730286964
  Medicare reassignment NPD

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1124610837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2823 GREYSTONE COMMERCIAL BLVD",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352422660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3569 PELHAM PKWY STE 7",
            "city": "PELHAM",
            "state": "AL",
            "postal_code": "351242033",
            "telephone_number": "205-664-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KICKER",
        "first_name": "ETHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH10221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PTH10221",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daphne R Kendrick, LCSW
• Kentros Dental LLC
• Megan S Kentros, O.D.
• Nicholas Kentros, D.M.D.
• Kevin L Morris DMD PC
• Michele C Kilgore, CCC-SLP
• Kimberly S. Williams, LLC
• Corie King, OTR
• Dana D King
• Lafronza J King, M.S. CCC-SLP

• Physical Therapist in Pelham, AL
• Providers in Pelham, AL by specialty
• Physical Therapist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; 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.