Active NPI
E. Kelton Cullenberg, DPT
- Physical Therapist
- Portland, ME
National Provider Identifier
1316469125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT4854
- Practice address
- 1173 Riverside St
Portland, ME 04103-1329 - Phone
- (207) 860-0307
- NPI assigned
- Jul 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 Therapist | 225100000X | PT4854 | ME | Primary |
Addresses
Primary practice location
1173 Riverside St
Portland, ME 04103-1329
Mailing address
35 Stevens LN
Brownfield, ME 04010-4774
Other practice location 1
15 U.S. 302
Glen, NH 03838
Phone (603) 383-7009
Other practice location 2
37 Main St
Conway, NH 03818-6166
Phone (603) 447-2533
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615852800000",
"number": "1316469125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 STEVENS LN",
"city": "BROWNFIELD",
"state": "ME",
"postal_code": "040104774"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1173 RIVERSIDE ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041031329",
"telephone_number": "207-860-0307"
}
],
"practiceLocations": [
{
"address_1": "15 U.S. 302",
"address_purpose": "LOCATION",
"city": "Glen",
"state": "NH",
"postal_code": "03838",
"country_code": "US",
"telephone_number": "603-383-7009",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "37 Main St",
"address_purpose": "LOCATION",
"city": "Conway",
"state": "NH",
"postal_code": "038186166",
"country_code": "US",
"telephone_number": "603-447-2533",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CULLENBERG",
"first_name": "E. KELTON",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-13",
"last_updated": "2021-03-16",
"certification_date": "2021-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ME",
"license": "PT4854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.