Kelley B Penrose, MPT,CCI

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

05-007738A Issued in IN

Practice address

10420 Acorn CT
Osceola, IN 46561-9330

Phone

(574) 238-6397

NPI assigned

Sep 16, 2006

Last updated

Aug 26, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377475200000",
    "number": "1487750527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 796",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465300796",
            "telephone_number": "574-238-6397",
            "fax_number": "574-329-5243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10420 ACORN CT",
            "city": "OSCEOLA",
            "state": "IN",
            "postal_code": "465619330",
            "telephone_number": "574-238-6397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENROSE",
        "first_name": "KELLEY",
        "middle_name": "B",
        "credential": "MPT,CCI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2013-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT21304",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IN",
            "license": "05-007738A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891690000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AB762Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hayley Mullins
• National Mentor Healthcare, LLC (Indiana Mentor Adult Foster Care)
• Jennifer W Njihia, FNP
• Steven Carl Obert, DC
• Joshua Ryan Tiller Pattengale, D.C.
• Stephanie Peper, MA, CCC-SLP
• Grace Phillips, LMHCA
• David Jordan Pirtle, DC
• Danielle Elizabeth Plavsa, M.S., CCC-SLP
• Ronald William Powell, M.D.

• Orthopedic Physical Therapist in Osceola, IN
• Providers in Osceola, IN by specialty
• Orthopedic Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; 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.