Taylor Joseph Kettman, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

096703 Issued in IA

Practice address

4612 Prairie Pkwy
Cedar Falls, IA 50613-7971

Phone

(319) 232-2630

NPI assigned

Jul 8, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cedar Valley Medical Specialists PC

  • Orthopaedic Surgery Physician
  • Waterloo, IA
  • NPI 1497794242
  Medicare reassignment NPD
• Cedar Valley Medical Specialists PC

  • Durable Medical Equipment & Medical Supplies
  • Vinton, IA
  • NPI 1659934180
  NPD
• Cedar Valley Medical Specialists PC

  • Durable Medical Equipment & Medical Supplies
  • Waverly, IA
  • NPI 1073567780
  NPD (past)

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

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1972165116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2758",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507042758",
            "telephone_number": "319-235-5390",
            "fax_number": "319-233-1630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4612 PRAIRIE PKWY",
            "city": "CEDAR FALLS",
            "state": "IA",
            "postal_code": "506137971",
            "telephone_number": "319-232-2630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1631 Logan Ave",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "IA",
            "postal_code": "507031237",
            "country_code": "US",
            "telephone_number": "319-232-2630",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "125 E Tower Park Dr",
            "address_purpose": "LOCATION",
            "city": "Waterloo",
            "state": "IA",
            "postal_code": "507019330",
            "country_code": "US",
            "telephone_number": "319-232-6339",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2351 Hudson Rd Ste 164",
            "address_purpose": "LOCATION",
            "city": "Cedar Falls",
            "state": "IA",
            "postal_code": "506140065",
            "country_code": "US",
            "telephone_number": "319-273-5265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KETTMAN",
        "first_name": "TAYLOR",
        "middle_name": "JOSEPH",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-08",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "096703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "taylor.kettman@cvms.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "CVMS",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "4612 Prairie Pkwy",
            "city": "Cedar Falls",
            "state": "IA",
            "country_code": "US",
            "postal_code": "506137971",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christa Ellen Kelly, P.T.
• Christene Mary Kelly, RN
• Keaton John Kelly
• Cory M Kennedy
• Melody K Kern, ARNP
• Morgan Kidder
• Andrew Kikuta, MD
• Howard T Kim, MD
• Samuel Kim, D.D.S.
• Kimball and Beecher PLLC

• Physical Therapist in Cedar Falls, IA
• Providers in Cedar Falls, IA by specialty
• Physical Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.