Ken J Gailes, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT3460 Issued in MS

Practice address

117 East Ave S
Hollandale, MS 38748-3811

Phone

(601) 624-0350

Fax

(601) 661-8457

NPI assigned

May 13, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1881986453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W CAMPBELL AVE",
            "address_2": "APT 1119",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850132998",
            "telephone_number": "601-624-0350",
            "fax_number": "601-661-8457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 EAST AVE S",
            "city": "HOLLANDALE",
            "state": "MS",
            "postal_code": "387483811",
            "telephone_number": "601-624-0350",
            "fax_number": "601-661-8457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAILES",
        "first_name": "KEN",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-13",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT3460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Hollandale, MS
• Providers in Hollandale, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; 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.