Eugene Ketselman, PT, DPT, FAAOMPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01566100 Issued in NJ

Practice address

1200 US Highway 22 East
Suite 2000 Unit W7
Bridgewater, NJ 08807-2943

Phone

(908) 304-3620

NPI assigned

Sep 2, 2014

Last updated

Oct 3, 2019By the provider in NPPES

Sex

Male

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)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Convergent Movement and Performance LLC

  • Physical Therapy Clinic/Center
  • Bridgewater, NJ
  • NPI 1104358787
  NPD (past) Authorized official
• Proactivity Fitness Physical Therapy Associates

  dba Pro-Activity

  • Physical Therapist
  • Lebanon, NJ
  • NPI 1265038160
  NPD

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

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1639579279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 US HIGHWAY 202",
            "address_2": "SUITE 320 UNIT 200",
            "city": "BRIDGEWATER",
            "state": "NJ",
            "postal_code": "088072737",
            "telephone_number": "908-304-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 US HIGHWAY 22 EAST",
            "address_2": "SUITE 2000 UNIT W7",
            "city": "BRIDGEWATER",
            "state": "NJ",
            "postal_code": "088072943",
            "telephone_number": "908-304-3620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "223 Stirling Rd",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "NJ",
            "postal_code": "070595238",
            "country_code": "US",
            "telephone_number": "908-304-3620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETSELMAN",
        "first_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, FAAOMPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-02",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01566100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Keener
• Mari F Kelly, MSC ATR
• Vanessa C Kelly, LPC
• Asia Kersey, OT
• Alexander Ketselman, CMT
• Keystone Community Living, Inc.
• Amber Manzoor Khan, M.D.
• Imran Khan, M.D
• Umbareen Khan
• Pawel Kielczewski, RRT

• Physical Therapist in Bridgewater, NJ
• Providers in Bridgewater, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.