Active NPI
Kassandra Marcella Jerome, PTA
- Physical Therapy Assistant
- Kissimmee, FL
National Provider Identifier
1710570817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 30494
- Practice address
- 830 29TH St, Orlando, FL 32805
Kissimmee, FL 32805 - Phone
- (407) 843-3230
- NPI assigned
- Feb 19, 2021
- Sex
- Female
- Sole proprietor
- No
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 | 30494 | FL | Primary |
Addresses
Primary practice location
830 29TH St, Orlando, FL 32805
Kissimmee, FL 32805
Mailing address
2519 Chapala Dr
Kissimmee, FL 34746-3447
Phone (321) 284-7591
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 |
|---|---|---|---|
| 30494 | FL | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613692800000",
"number": "1710570817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2519 CHAPALA DR",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347463447",
"telephone_number": "321-284-7591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 29TH ST, ORLANDO, FL 32805",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "32805",
"telephone_number": "407-843-3230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEROME",
"first_name": "KASSANDRA",
"middle_name": "MARCELLA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-19",
"last_updated": "2021-02-19",
"certification_date": "2021-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "30494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.