Kelly Ibe, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160500252 Issued in WA

Practice address

13333 Greenwood Ave N
Seattle, WA 98133-7312

Phone

(206) 446-8294

NPI assigned

May 9, 2015

Last updated

May 9, 2015By 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 1

Addresses

Other names 1

• Kelly Pettiss Former name

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": "1431129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431129600000",
    "number": "1669850715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13333 GREENWOOD AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981337312",
            "telephone_number": "206-446-8294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13333 GREENWOOD AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981337312",
            "telephone_number": "206-446-8294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBE",
        "first_name": "KELLY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-09",
        "last_updated": "2015-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160500252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "PETTISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Taylor Shea McGuire Ibanez, BCBA, LBA
• Brandon Ibarra
• Elizabeth Rose Ibarra
• Gabriella Ibarra
• Shaelene Ibbetson, MS CCC-SLP
• Amanda Kiyono Ibrahim, OTR/L
• Anisa Mohamed Ibrahim
• David Albeer Ibrahim, MD
• Hawi K Ibrahim, RN
• Hoda Ibrahim, PHARMD

• Physical Therapy Assistant in Seattle, WA
• Providers in Seattle, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2015; 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.