Jacob Kettner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CP034808T Issued in MO

Practice address

540 E Young Ave Ste E
Warrensburg, MO 64093-1250

Phone

(660) 262-4795

NPI assigned

Aug 9, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AR, MO2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Physical Therapy LLCGroup PAC ID 5395032882, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Advanced Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Rogers, AR
  • NPI 1427401702

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Serc Rehabilitation Partners, LLC

  dba Serc

  • Physical Therapist
  • Belton, MO
  • NPI 1760745244
  Medicare reassignment NPD
• Serc Rebabilitation Partners, LLC

  • Physical Therapist
  • Overland Park, KS
  • NPI 1598190209
  NPD

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

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1225683808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 E YOUNG AVE STE E",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640931250",
            "telephone_number": "660-262-4795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3399 Black Forest Dr Ste 3",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727046541",
            "country_code": "US",
            "telephone_number": "417-300-9965",
            "fax_number": "417-494-4173",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6815 Isaacs Orchard Rd Ste D",
            "address_purpose": "LOCATION",
            "city": "Springdale",
            "state": "AR",
            "postal_code": "727626285",
            "country_code": "US",
            "telephone_number": "479-856-6400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETTNER",
        "first_name": "JACOB",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-09",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "CP034808T",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT4666",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason L. Kearbey, LPC
• Kenneth J Keirsey, O.D.
• Michael Jon Kelledes, LPC
• Cassandra Keller
• Bridget Drucilla Kennedy
• Adam Kimbrough
• Gretchen Riley Kimmel
• Taylor King
• Chloe Kinney
• April E Kirby, PLPC

• Physical Therapist in Warrensburg, MO
• Providers in Warrensburg, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; 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.