Active NPI
Keisha Ellis, PT
- Physical Therapist
- Campbellsville, KY
National Provider Identifier
1629358387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 003910
- Practice address
- 105 Laura Sue Humphress Dr
Campbellsville, KY 42718-8899 - Phone
- (270) 465-7768
- Fax
- (270) 465-0068
- NPI assigned
- Aug 25, 2011
- 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 Therapist | 225100000X | 003910 | KY | Primary |
Addresses
Primary practice location
105 Laura Sue Humphress Dr
Campbellsville, KY 42718-8899
Mailing address
514 Turkey Run Rd
Campbellsville, KY 42718-4929
Phone (270) 463-6173
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 |
|---|---|---|---|
| 003910 | KY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314230400000",
"number": "1629358387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "514 TURKEY RUN RD",
"city": "CAMPBELLSVILLE",
"state": "KY",
"postal_code": "427184929",
"telephone_number": "270-463-6173",
"fax_number": "270-465-0068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 LAURA SUE HUMPHRESS DR",
"city": "CAMPBELLSVILLE",
"state": "KY",
"postal_code": "427188899",
"telephone_number": "270-465-7768",
"fax_number": "270-465-0068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "KEISHA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-25",
"last_updated": "2011-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KY",
"license": "003910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Campbellsville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.