Jessica Ann Pauly, PT, DPT
Individual provider Active NPI Physical Therapist · Goddard, KS
NPI 1306338629 · NPPES record last updated May 11, 2023
Key facts
- NPI
- 1306338629
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11-05885 (KS)
- Practice address
- 19931 W Kellogg Dr Unit a
Goddard, KS 67052-8864 - Phone
- (316) 550-6132
- Fax
- (316) 550-6215
- NPI assigned
- Jun 1, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- University of Kansas School of Med (KC/Wich/Sal), 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Harter Physical Therapy LLC
Practice addresses (Care Compare)
19931 W Kellogg Dr
Goddard, KS 67052-8864
Phone (316) 550-6132
501 E Ross St
Harter Physical Therapy
Clearwater, KS 67026-7829
Phone (316) 550-6132
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220921002871 | KS | Practitioner - Physical Therapist in Private Practice | 5496130890 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11-05885 | KS | Yes |
Addresses
Primary practice location
19931 W Kellogg Dr Unit a
Goddard, KS 67052-8864
Mailing address
3400 Meadowlark LN
Great Bend, KS 67530-7541
Phone (620) 545-5248
Other names
- Jessica Ann Ebenkamp
Other providers in Goddard, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.