Jordan Kimball

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12276 Issued in SC

Practice address

130 Crisanto Ave Ste a
Fort Mill, SC 29715-6272

Phone

(803) 746-4655

NPI assigned

May 27, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in SC, NC2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Focus, Inc.Group PAC ID 5890851406, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Ivyrehab Focus, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Lake Wylie, SC
  • NPI 1518105279

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Architech Sports and Physical Therapy, LLC

  • Orthopedic Physical Therapist
  • Fort Mill, SC
  • NPI 1134894389
  Medicare reassignment NPD
• Ivyrehab North Carolina LLC

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
  • NPI 1629568647

  Physical Therapist

  Medicare reassignment NPD
• Ivyrehab Focus, Inc.

  • Physical Medicine & Rehabilitation Physician
  • Rock Hill, SC
  • NPI 1902443880
  NPD
• Ivyrehab North Carolina LLC

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
  • NPI 1528683935
  NPD
• Architech Sports and Physical Therapy, LLC

  • Orthopedic Physical Therapist
  • Charlotte, NC
  • NPI 1780834697
  NPD (past)

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

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1417696535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412066",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CRISANTO AVE STE A",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297156272",
            "telephone_number": "803-746-4655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3485 Windsor Ave",
            "address_purpose": "LOCATION",
            "city": "Dubuque",
            "state": "IA",
            "postal_code": "520011329",
            "country_code": "US",
            "telephone_number": "563-557-7180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2100 N Davidson St Ste C",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282051828",
            "country_code": "US",
            "telephone_number": "980-556-7780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "JORDAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-27",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "114750",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P22943",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "12276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Marie Kidder, PT
• Sophia T Kieffer
• Michele Killion, LPCA
• Kim Engel-Hughes, LPC, LLC
• Lawrence Kimani
• Keenya Kimbrell, LPN
• Paige Hutson Kinder, OT
• Carolyn Politi King
• Caylee King, LPCA, LCMHCA, NCC
• Garrett King, DPT

• Physical Therapist in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.