Kimberly D Ellsworth, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0400003140 Issued in VT

Practice address

1 Market PL
Suite #27&33
Essex Junction, VT 05452-2942

Phone

(802) 878-9572

Fax

(802) 878-9592

NPI assigned

Jul 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Vermont College of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leclair Therapy IncGroup PAC ID 4688631211, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Leclair Therapy, Inc.

  • Physical Therapist
  • Essex JCT, VT
  • NPI 1821002189
  Medicare reassignment Care Compare group NPD
• Ellsworth Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Essex Junction, VT
  • NPI 1861423873

  Physical Therapist

  NPD (past) Authorized official

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760413827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SHIRLEY CIR",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054957351",
            "telephone_number": "802-879-3545",
            "fax_number": "802-878-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MARKET PL",
            "address_2": "SUITE #27&33",
            "city": "ESSEX JUNCTION",
            "state": "VT",
            "postal_code": "054522942",
            "telephone_number": "802-878-9572",
            "fax_number": "802-878-9592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSWORTH",
        "first_name": "KIMBERLY",
        "middle_name": "D",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "0400003140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008564",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tilyr Alfred Dunklow, D.C., B.S.
• Mark Dziadek, MPT
• Blagorodna Efremovski, LCMHC., LADC
• Jen Ellis, M.S., M.ED.
• Ellsworth Physical Therapy, Inc.
• Empower Therapy, LLC
• Hannah Engelken, LICSW
• Essex Family Dental
• Essex Rescue Inc
• Essex Westford Educational Community Unified Union School District

• Physical Therapist in Essex Junction, VT
• Providers in Essex Junction, VT by specialty
• Physical Therapist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.