Active NPI
Kyle Jenkins, PTA
- Physical Therapist
- Springfield, IL
National Provider Identifier
1992263792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 49514
- Practice address
- 112 Calvin Ave
Springfield, IL 62704-6112 - Phone
- (217) 652-2830
- NPI assigned
- Mar 11, 2019
- Sex
- Male
- 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 | 49514 | CA | Primary |
Addresses
Primary practice location
112 Calvin Ave
Springfield, IL 62704-6112
Mailing address
112 Calvin Ave
Springfield, IL 62704-6112
Phone (217) 652-2830
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552262400000",
"number": "1992263792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 CALVIN AVE",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627046112",
"telephone_number": "217-652-2830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 CALVIN AVE",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627046112",
"telephone_number": "217-652-2830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "KYLE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-11",
"last_updated": "2019-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "49514",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.