Active NPI
Kelly Christine Hettenbaugh, PTA
- Physical Therapy Assistant
- Naples, FL
National Provider Identifier
1205235298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 25096
- Practice address
- 661 Goodlette Rd N
Suite 101
Naples, FL 34102-5609 - Phone
- (239) 261-4592
- NPI assigned
- Aug 15, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 25096 | FL | Primary |
Addresses
Primary practice location
661 Goodlette Rd N
Suite 101
Naples, FL 34102-5609
Mailing address
661 Goodlette Rd N
Suite 101
Naples, FL 34102-5609
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 |
|---|---|---|---|
| 25096 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fyzbiz, LLC | Past | Accepting new patients | |
| Medical & Sports Rehabilitation Center Inc | Physical Therapy Assistant | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba FYZICAL Therapy and Balance Centers
- Rehabilitation Clinic/Center
- Fort Myers, FL
- NPI 1700248887
-
- Physical Therapist
- Naples, FL
- NPI 1558315663
Physical Therapy Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408060800000",
"number": "1205235298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "661 GOODLETTE RD N",
"address_2": "SUITE 101",
"city": "NAPLES",
"state": "FL",
"postal_code": "341025609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "661 GOODLETTE RD N",
"address_2": "SUITE 101",
"city": "NAPLES",
"state": "FL",
"postal_code": "341025609",
"telephone_number": "239-261-4592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETTENBAUGH",
"first_name": "KELLY",
"middle_name": "CHRISTINE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-15",
"last_updated": "2014-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "25096",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Naples, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.