Active NPI
Kaitlyn Story
- Physical Therapy Assistant
- Kankakee, IL
National Provider Identifier
1306241963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 16006902
- Practice address
- 1601 Butterfield TRL
Kankakee, IL 60901-2959 - Phone
- (815) 936-6500
- NPI assigned
- Oct 24, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 16006902 | IL | Primary |
| Physical Therapy Assistant | 225200000X | 06004893A | IN |
Addresses
Primary practice location
1601 Butterfield TRL
Kankakee, IL 60901-2959
Mailing address
4560 SE International Way
Stu 100
Milwaukie, OR 97222-4628
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 |
|---|---|---|---|
| 16006902 | IL | MD | Physical Therapy Assistant |
| 06004893A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414108800000",
"number": "1306241963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY",
"address_2": "STU 100",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972224628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 BUTTERFIELD TRL",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012959",
"telephone_number": "815-936-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STORY",
"first_name": "KAITLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-24",
"last_updated": "2014-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "16006902",
"primary": true
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06004893A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.