Keegan Kimminau, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11-07283 Issued in KS

Practice address

5345 Marian LN
Virginia Beach, VA 23462-1841

Phone

(757) 456-5018

NPI assigned

Jul 17, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Riley Kimminau 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": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1740969856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 TIMBER VALLEY DR",
            "city": "LINN VALLEY",
            "state": "KS",
            "postal_code": "660405396",
            "telephone_number": "913-244-1690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5345 MARIAN LN",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234621841",
            "telephone_number": "757-456-5018"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "810 Jasmine St",
            "address_purpose": "LOCATION",
            "city": "Omak",
            "state": "WA",
            "postal_code": "988419578",
            "country_code": "US",
            "telephone_number": "509-826-1760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMMINAU",
        "first_name": "KEEGAN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-17",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "CP031999T",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-07283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RILEY",
            "last_name": "KIMMINAU",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Younghwan Juan Kim, LCSW
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• Bernadette Kimbrell
• Carolyn Kimes, FNP
• Carrie Goodman Kinas, PA-C
• Kind Heart Home Care, LLC
• Samantha Duplak Kindelsperger, OD
• Kindhearted Supportive Services LLC
• Brittani Michelle Kindle, LCSW

• All providers in Virginia Beach, VA
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.