Kimberly Sue Kettinger, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA19199 Issued in FL

Practice address

625 Overlook Dr
Winter Haven, FL 33884-1626

Phone

(863) 318-1315

Fax

(863) 326-9432

NPI assigned

Mar 14, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Sue Halterman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1215060520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3828 SARRIA AVE",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "338722300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 OVERLOOK DR",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338841626",
            "telephone_number": "863-318-1315",
            "fax_number": "863-326-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTINGER",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA19199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "HALTERMAN",
            "middle_name": "SUE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joseph Scott Kennedy, DNP, APRN, FNP-C
• Kenneth B Rogers DMD PA
• Patricia Rodriguez Kent, NP
• Michael L Keown, MD
• Kesha Health Care Service,LLC
• Kevin L. Henne O.D.
• Kevin T. Barlow, PA
• Keyhole Surgery Center-Winter Haven LLC
• Farah Khan, MD
• Mehak Khan, OD

• Physical Therapy Assistant in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.