Active NPI
Kelli Koba
- Physical Therapist
- Warrensville Heights, OH
National Provider Identifier
1962065318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT017068
- Practice address
- 4700 Richmond Rd Ste 100
Warrensville Heights, OH 44128-5985 - Phone
- (216) 378-9390
- Fax
- (216) 378-9391
- NPI assigned
- Apr 20, 2019
- Sex
- Female
- Sole proprietor
- No
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 | PT017068 | OH | Primary |
Addresses
Primary practice location
4700 Richmond Rd Ste 100
Warrensville Heights, OH 44128-5985
Mailing address
3310 Warren Rd
Cleveland, OH 44111-2031
Phone (216) 941-5656
Other practice location 1
3310 Warren Rd
Cleveland, OH 44111-2031
Phone (216) 941-5656
Other practice location 2
26250 Euclid Ave Ste 711
Euclid, OH 44132-3694
Phone (216) 261-7715
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 |
|---|---|---|---|
| PT017068 | OH | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Lifeforce Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Chiropractor
- Cleveland, OH
- NPI 1811280910
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611619200000",
"number": "1962065318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3310 WARREN RD",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441112031",
"telephone_number": "216-941-5656",
"fax_number": "216-532-2236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 RICHMOND RD STE 100",
"city": "WARRENSVILLE HEIGHTS",
"state": "OH",
"postal_code": "441285985",
"telephone_number": "216-378-9390",
"fax_number": "216-378-9391"
}
],
"practiceLocations": [
{
"address_1": "3310 Warren Rd",
"address_purpose": "LOCATION",
"city": "Cleveland",
"state": "OH",
"postal_code": "441112031",
"country_code": "US",
"telephone_number": "216-941-5656",
"fax_number": "216-532-2236",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "26250 Euclid Ave Ste 711",
"address_purpose": "LOCATION",
"city": "Euclid",
"state": "OH",
"postal_code": "441323694",
"country_code": "US",
"telephone_number": "216-261-7715",
"fax_number": "216-261-7746",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOBA",
"first_name": "KELLI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-20",
"last_updated": "2021-01-26",
"certification_date": "2021-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "PT017068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warrensville Heights, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.