Individual provider Active NPI

Kathleen A Antares, DPT

  • Physical Therapist
  • St Petersburg, FL
National Provider Identifier
1730412354
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT35350 Issued in FL
Practice address
4660 22ND Ave S
Saint Petersburg, FL 33711-2924
Phone
(336) 473-3387
NPI assigned
Sep 14, 2009
Last updated
Jan 18, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

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

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1254561 TX
Cardiopulmonary Physical Therapist 2251C2600X PT35350 FL
Geriatric Physical Therapist 2251G0304X PT35350 FL
Pediatric Physical Therapist 2251P0200X PT35350 FL
Sports Physical Therapist 2251S0007X PT35350 FL
Orthopedic Physical Therapist 2251X0800X PT35350 FL
Physical Therapist 225100000X PT35350 FL Primary

Addresses

Primary practice location

4660 22ND Ave S
Saint Petersburg, FL 33711-2924

Mailing address

4660 22ND Ave S
Saint Petersburg, FL 33711-2924
Phone (336) 473-3387

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210623003872 FL Practitioner - Physical Therapist in Private Practice 1850792136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
83.26 of 100Reported as group
Quality
86.58
Improvement activities
40
Cost
68.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1254561TXMDPhysical Therapist
PT35350FLMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Luna Care Physical Therapy LLC Physical Therapist CurrentSince Jun 10, 2021 Accepting new patients

Locations

5011 Gate Pkwy
Ste 100
Jacksonville, FL 32256
Phone (904) 326-3627

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1730412354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4660 22ND AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337112924",
            "telephone_number": "336-473-3387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 22ND AVE S",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337112924",
            "telephone_number": "336-473-3387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTARES",
        "first_name": "KATHLEEN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1254561",
            "primary": false
        },
        {
            "code": "2251C2600X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Cardiopulmonary",
            "state": "FL",
            "license": "PT35350",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "FL",
            "license": "PT35350",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "FL",
            "license": "PT35350",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "FL",
            "license": "PT35350",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "FL",
            "license": "PT35350",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT35350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.