Individual provider Active NPI

Jacinta Velasquez, PTA

  • Physical Therapy Assistant
  • Louisville, KY
National Provider Identifier
1417269846
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
A02561 Issued in KY
Practice address
4022 Bardstown Rd Ste B
Louisville, KY 40218-2649
Phone
(606) 233-8270
Fax
(502) 882-1214
NPI assigned
Jul 14, 2010
Last updated
Sep 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X A02561 KY Primary

Addresses

Primary practice location

4022 Bardstown Rd Ste B
Louisville, KY 40218-2649

Mailing address

4022 Bardstown Rd Ste B
Louisville, KY 40218-2649
Phone (606) 233-8270

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

LicenseStateTypeSpecialty
A02561KYMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rehab Group LLC CurrentSince Sep 1, 2024 Accepting new patients

Locations

4022 Bardstown Rd
Ste B
Louisville, KY 40218
Phone (606) 233-8270

5330 S 3rd St
Ste 228
Louisville, KY 40214
Phone (502) 305-6445

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1279065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1417269846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4022 BARDSTOWN RD STE B",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182649",
            "telephone_number": "606-233-8270",
            "fax_number": "502-882-1214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4022 BARDSTOWN RD STE B",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182649",
            "telephone_number": "606-233-8270",
            "fax_number": "502-882-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELASQUEZ",
        "first_name": "JACINTA",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-14",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KY",
            "license": "A02561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.