Kimberly Kay Ceroll, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

852A Issued in ND

Practice address

430 5TH St N
Breckenridge, MN 56520-1426

Phone

(218) 641-7725

NPI assigned

Dec 12, 2019

Last updated

Dec 12, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1576108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576108800000",
    "number": "1528606258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 5TH ST N",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565201426",
            "telephone_number": "218-641-7725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 5TH ST N",
            "city": "BRECKENRIDGE",
            "state": "MN",
            "postal_code": "565201426",
            "telephone_number": "218-641-7725"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 5th St SW",
            "address_purpose": "LOCATION",
            "city": "Hankinson",
            "state": "ND",
            "postal_code": "580414417",
            "country_code": "US",
            "telephone_number": "218-641-7725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CEROLL",
        "first_name": "KIMBERLY",
        "middle_name": "KAY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-12",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MN",
            "license": "A276",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ND",
            "license": "852A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSE",
            "identifier": "A276",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSE",
            "identifier": "852A",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Breckenridge, MN
• Providers in Breckenridge, MN by specialty
• Physical Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; 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.