Individual provider Active NPI

Adam C Kibler, PTA

  • Physical Therapy Assistant
  • Ravenna, OH
National Provider Identifier
1780705681
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA3122 Issued in OH
Practice address
565 Bryn Mawr St
Ravenna, OH 44266-9696
Phone
(330) 297-5781
Fax
(330) 297-6921
NPI assigned
Apr 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA3122 OH Primary

Addresses

Primary practice location

565 Bryn Mawr St
Ravenna, OH 44266-9696

Mailing address

3910 Aumanson St NW
Uniontown, OH 44685-8444
Phone (330) 297-5781

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

LicenseStateTypeSpecialty
PTA3122OHMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780705681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 AUMANSON ST NW",
            "city": "UNIONTOWN",
            "state": "OH",
            "postal_code": "446858444",
            "telephone_number": "330-297-5781",
            "fax_number": "330-297-6921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 BRYN MAWR ST",
            "city": "RAVENNA",
            "state": "OH",
            "postal_code": "442669696",
            "telephone_number": "330-297-5781",
            "fax_number": "330-297-6921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIBLER",
        "first_name": "ADAM",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OH",
            "license": "PTA3122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ravenna, OH

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.