Active NPI
Kelsey Worden
- Physical Therapy Assistant
- Port Orange, FL
National Provider Identifier
1124665740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A04066
- Practice address
- 5535 S Williamson Blvd Ste 774
Port Orange, FL 32128-8321 - Phone
- (888) 265-2680
- NPI assigned
- Dec 2, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2150938 | TX | |
| Physical Therapy Assistant | 225200000X | PA4499 | ME | |
| Physical Therapy Assistant | 225200000X | A04066 | KY | Primary |
Addresses
Primary practice location
5535 S Williamson Blvd Ste 774
Port Orange, FL 32128-8321
Mailing address
57 Woodland Rd
Princeton, ME 04668-3158
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A04066 | KY | MD | Physical Therapy Assistant |
| PA4499 | ME | MD | Physical Therapy Assistant |
| 2150938 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575244800000",
"number": "1124665740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "57 WOODLAND RD",
"city": "PRINCETON",
"state": "ME",
"postal_code": "046683158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5535 S WILLIAMSON BLVD STE 774",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321288321",
"telephone_number": "888-265-2680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORDEN",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-02",
"last_updated": "2019-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2150938",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ME",
"license": "PA4499",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "KY",
"license": "A04066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.