Active NPI
Kelly Leigh Kierstead, PTA
- Physical Therapy Assistant
- Canon City, CO
National Provider Identifier
1386315794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA.0012399
- Practice address
- 515 Fairview Ave
Canon City, CO 81212-2863 - Phone
- (719) 275-0665
- NPI assigned
- Sep 24, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA.0012399 | CO | Primary |
Addresses
Primary practice location
515 Fairview Ave
Canon City, CO 81212-2863
Mailing address
PO Box 161
Rockvale, CO 81244-0161
Phone (719) 225-3967
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 |
|---|---|---|---|
| PTA.0012399 | CO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632441600000",
"number": "1386315794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 161",
"city": "ROCKVALE",
"state": "CO",
"postal_code": "812440161",
"telephone_number": "719-225-3967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 FAIRVIEW AVE",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812122863",
"telephone_number": "719-275-0665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIERSTEAD",
"first_name": "KELLY",
"middle_name": "LEIGH",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-24",
"last_updated": "2021-09-24",
"certification_date": "2021-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CO",
"license": "PTA.0012399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canon City, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.