Individual provider Active NPI

Rebecca Jill Kennedy, DPT

  • Physical Therapist
  • Worcester, MA
National Provider Identifier
1770980955
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
21118 Issued in MA
Practice address
484 Main St
Worcester, MA 01608-1893
Phone
(800) 244-2756
Fax
(508) 831-9768
NPI assigned
Dec 3, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 21118 MA Primary

Addresses

Primary practice location

484 Main St
Worcester, MA 01608-1893

Mailing address

33 E Chestnut St
Apartment 2
Sharon, MA 02067-2032
Phone (616) 745-4957

Other identifiers 1

IdentifierTypeStateIssuer
21118OtherMA PHYSICAL THERAPY LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220222000209 MI Practitioner - Physical Therapist in Private Practice 9537553367 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advent Rehabilitation, LLCGroup PAC ID 9537070545, 57 clinicians

Practice addresses (Care Compare)

245 Cherry St SE
Suite 102
Grand Rapids, MI 49503-4607
Phone (616) 201-3909

3686 32ND Ave
Suite 400
Hudsonville, MI 49426-8546
Phone (616) 377-1010

4085 Burton St SE
Suite 100
Grand Rapids, MI 49546-2444
Phone (616) 233-3599

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21118MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advent Rehabilitation, LLC Physical Therapist CurrentSince Feb 14, 2022 Accepting new patients
Advent Rehabilitation, LLC Physical Therapist CurrentSince Feb 14, 2022 Accepting new patients

Locations

6745 Fulton St E
Ste D
Ada, MI 49301
Phone (616) 274-1014

245 Cherry St SE
Ste 102
Grand Rapids, MI 49503
Phone (616) 201-3909

933 3 Mile Rd NW
Ste 104
Grand Rapids, MI 49544
Phone (616) 233-3592

4085 Burton St SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 233-3599

625 Kenmoor Ave SE
Ste 100
Grand Rapids, MI 49546

3380 44th St SW
Grandville, MI 49418
Phone (616) 685-8250

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417564800000",
    "number": "1770980955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 E CHESTNUT ST",
            "address_2": "APARTMENT 2",
            "city": "SHARON",
            "state": "MA",
            "postal_code": "020672032",
            "telephone_number": "616-745-4957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 MAIN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016081893",
            "telephone_number": "800-244-2756",
            "fax_number": "508-831-9768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "REBECCA",
        "middle_name": "JILL",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "21118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA PHYSICAL THERAPY LICENSE",
            "identifier": "21118",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; 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.