Kathleen Annette Ellis

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06002780A Issued in IN

Practice address

426 S Alabama St Ste 200
Indianapolis, IN 46225-3301

Phone

(317) 528-6804

Fax

(317) 528-3781

NPI assigned

Sep 16, 2024

Last updated

Oct 21, 2024By 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 1

Addresses

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": "1726444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1629805429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 781076",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482781076",
            "telephone_number": "317-528-4800",
            "fax_number": "317-865-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 S ALABAMA ST STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462253301",
            "telephone_number": "317-528-6804",
            "fax_number": "317-528-3781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8111 S Emerson Ave",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462378601",
            "country_code": "US",
            "telephone_number": "317-528-8578",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "KATHLEEN",
        "middle_name": "ANNETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-16",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06002780A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harriett Ellis
• Jennifer L Ellis, P.T.
• John Conard Ellis, MD
• Karah Ellis
• Karen Elizabeth Ellis, DDS
• Kayla Ellis, MD
• Pamela Sue Ellis, RPH
• Ryan Joseph Ellis, MD
• Shaneise Ellis, MD, MBA
• Shannon Marie Ellis

• Physical Therapy Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Physical Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.