Cynthia Vida Ketter, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2595 Issued in WI

Practice address

1435 W. Mason St.
Ste. 104
Green Bay, WI 54303

Phone

(920) 737-4135

Fax

(920) 490-9705

NPI assigned

May 14, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144436775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618A PAINE ST",
            "city": "KIEL",
            "state": "WI",
            "postal_code": "530421042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 W. MASON ST.",
            "address_2": "STE. 104",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54303",
            "telephone_number": "920-737-4135",
            "fax_number": "920-490-9705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTER",
        "first_name": "CYNTHIA",
        "middle_name": "VIDA",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "2595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Keranen, COTA
• Jennifer Kerelko, BCBA
• Tricia Ann Kerker, LPC
• Aliece Ann Kerscher
• Kyle Kershek, LPC
• Rebecca L Ketterhagen, PA
• Masin Kettner
• Keystone Psychology LLC
• Sany T Khabbaz, MD
• Hadi Mohammad Khan, M.D.

• Physical Therapist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.