Active NPI
Kaitlyn Moore
- Physical Therapy Assistant
- Ravenna, OH
National Provider Identifier
1679939698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA011221
- Practice address
- 6831 N Chestnut St
Ravenna, OH 44266-3929 - Phone
- (330) 297-4564
- NPI assigned
- Jan 6, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | PTA011221 | OH | Primary |
Addresses
Primary practice location
6831 N Chestnut St
Ravenna, OH 44266-3929
Mailing address
4843 Kelly Ave
Rootstown, OH 44272-9286
Phone (724) 714-9348
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 |
|---|---|---|---|
| PTA011221 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616544000000",
"number": "1679939698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4843 KELLY AVE",
"city": "ROOTSTOWN",
"state": "OH",
"postal_code": "442729286",
"telephone_number": "724-714-9348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6831 N CHESTNUT ST",
"city": "RAVENNA",
"state": "OH",
"postal_code": "442663929",
"telephone_number": "330-297-4564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "KAITLYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-06",
"last_updated": "2021-03-24",
"certification_date": "2021-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "PTA011221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ravenna, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.