Individual provider Active NPI

Vanessa Rae Ballard, PT

  • Physical Therapist
  • Sarasota, FL
National Provider Identifier
1679766737
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT13131 Issued in FL
Practice address
1727 2ND St Ste 2
Sarasota, FL 34236-8524
Phone
(941) 951-0170
Fax
(941) 993-1088
NPI assigned
Aug 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT13131 FL Primary

Addresses

Primary practice location

1727 2ND St Ste 2
Sarasota, FL 34236-8524

Mailing address

7216 US Highway 301 N
Suite 115
Ellenton, FL 34222-3462
Phone (941) 729-0003

Other identifiers 2

IdentifierTypeStateIssuer
PT13131OtherFLSTATE LICENSE
892505400MedicaidFL

Other names 1

  • Vanessa Rae Kurtenbach Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071113000302 FL Practitioner - Physical Therapist in Private Practice 7618065459 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Club 50, LLC CurrentSince Jan 4, 2024 Accepting new patients
Legacy Healthcare Inc Physical Therapist Past Accepting new patients
Legacy Healthcare Inc Physical Therapist Past Accepting new patients
Legacy Healthcare Inc Physical Therapist Past Accepting new patients
Total Therapy Solutions LLC Physical Therapist PastSince Jul 1, 2011 Accepting new patients

Locations

1727 2nd St
Ste 2
Sarasota, FL 34236
Phone (941) 951-0170

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1679766737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7216 US HIGHWAY 301 N",
            "address_2": "SUITE 115",
            "city": "ELLENTON",
            "state": "FL",
            "postal_code": "342223462",
            "telephone_number": "941-729-0003",
            "fax_number": "941-729-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 2ND ST STE 2",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342368524",
            "telephone_number": "941-951-0170",
            "fax_number": "941-993-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLARD",
        "first_name": "VANESSA",
        "middle_name": "RAE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT13131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PT13131",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "892505400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VANESSA",
            "last_name": "KURTENBACH",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sarasota, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.