NPIMap

Individual provider Active NPI

Kelley N Johannes, PT

  • Pediatric Physical Therapist
  • Spartanburg, SC
National Provider Identifier
1932250016
Registry record updated Dec 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
6818 Issued in SC
Practice address
2400 Winchester PL Ste 102B
Spartanburg, SC 29301-1518
Phone
(864) 574-7282
Fax
(864) 574-7664
NPI assigned
Jan 15, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 10792 NC
Pediatric Physical Therapist 2251P0200X
Pediatric Physical Therapist 2251P0200X 6818 SC Primary

Addresses

Primary practice location

2400 Winchester PL Ste 102B
Spartanburg, SC 29301-1518

Mailing address

139 Dewfield LN
Boiling Springs, SC 29316-6167
Phone (704) 785-5152

Other practice location 1

2711 Randolph Rd
Suite 509
Charlotte, NC 28207-2034
Phone (704) 491-1455

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

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Pediatric Therapy, LLC CurrentSince Dec 29, 2019 Accepting new patients
First Steps Pediatric Therapy Inc Pediatrics 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577318400000",
    "number": "1932250016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 DEWFIELD LN",
            "city": "BOILING SPRINGS",
            "state": "SC",
            "postal_code": "293166167",
            "telephone_number": "704-785-5152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 WINCHESTER PL STE 102B",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293011518",
            "telephone_number": "864-574-7282",
            "fax_number": "864-574-7664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2711 Randolph Rd",
            "address_2": "Suite 509",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282072034",
            "country_code": "US",
            "telephone_number": "704-491-1455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHANNES",
        "first_name": "KELLEY",
        "middle_name": "N",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NC",
            "license": "10792",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "SC",
            "license": "6818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2019; 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.