Kimberly Fellenbaum

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

TEI004832 Issued in PA

Practice address

1 S Home Ave
Topton, PA 19562-1317

Phone

(610) 682-1400

NPI assigned

Apr 15, 2016

Last updated

Mar 17, 2018By 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 3

Addresses

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": "1460678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1790139772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6024 PARKSIDE CT",
            "city": "EAST PETERSBURG",
            "state": "PA",
            "postal_code": "175201245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S HOME AVE",
            "city": "TOPTON",
            "state": "PA",
            "postal_code": "195621317",
            "telephone_number": "610-682-1400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5301 Creedmoor Rd",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276123822",
            "country_code": "US",
            "telephone_number": "919-424-5080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FELLENBAUM",
        "first_name": "KIMBERLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-15",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "6241",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TE010881",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TEI004832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Anthony Debalko
• Tracey Bower Delong, PT
• Diakon Child, Family & Community Ministries (Diakon Family Life Services Northeast)
• Diakon Lutheran Social Ministries (Diakon Family Life Services)
• Janine R Dreibelbis, OTR
• Kevin Fratis, PT
• Aaron Fritz, LSW
• Tina Lynn Fulton, P.T.
• Dawn R Grove, PTA
• Raymond Joseph Hauser, M.D.

• Physical Therapy Assistant in Topton, PA
• Providers in Topton, PA by specialty
• Physical Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.