Active NPI
Kelly Jean Pettesch, MPT
- Physical Therapist
- Monroe, OH
National Provider Identifier
1902084023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 012023
- Practice address
- 286 N Main St
Monroe, OH 45050-1236 - Phone
- (513) 539-3488
- NPI assigned
- Jan 31, 2008
- Last updated
- Mar 12, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 012023 | OH | Primary |
Addresses
Primary practice location
286 N Main St
Monroe, OH 45050-1236
Mailing address
7720 Dudley Dr
West Chester, OH 45069-2400
Phone (513) 779-5410
Other practice location 1
7236 Town Centre Dr
West Chester, OH 45069
Phone (513) 779-5410
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012023 | OH | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Therapeutic Services, Inc. | Physical Therapist | Past | Accepting new patients |
| Professional Therapeutic Services Inc | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba NovaCare Rehabilitation
- Physical Therapy Clinic/Center
- Huber Heights, OH
- NPI 1174529358
-
dba NovaCare Rehabilitation
- Physical Therapy Clinic/Center
- Piqua, OH
- NPI 1023686979
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583971200000",
"number": "1902084023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7720 DUDLEY DR",
"city": "WEST CHESTER",
"state": "OH",
"postal_code": "450692400",
"telephone_number": "513-779-5410",
"fax_number": "513-779-5413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "286 N MAIN ST",
"city": "MONROE",
"state": "OH",
"postal_code": "450501236",
"telephone_number": "513-539-3488"
}
],
"practiceLocations": [
{
"address_1": "7236 Town Centre Dr",
"address_purpose": "LOCATION",
"city": "West Chester",
"state": "OH",
"postal_code": "45069",
"country_code": "US",
"telephone_number": "513-779-5410",
"fax_number": "513-779-5413",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETTESCH",
"first_name": "KELLY",
"middle_name": "JEAN",
"name_prefix": "Miss",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-31",
"last_updated": "2020-03-12",
"certification_date": "2020-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "012023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.