Individual provider Active NPI

Kathryn Anne Moser, MPT, ATC

  • Physical Therapist
  • Rutland, VT
National Provider Identifier
1992812549
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
040.0072377 Issued in VT
Practice address
365 US Route 4 E
Rutland, VT 05701-9035
Phone
(802) 855-8068
Fax
(802) 855-8436
NPI assigned
Aug 23, 2006
Last updated
Apr 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT02086 RI
Physical Therapist 225100000X 040.0072377 VT Primary

Addresses

Primary practice location

365 US Route 4 E
Rutland, VT 05701-9035

Mailing address

365 US Route 4 E
Rutland, VT 05701-9035
Phone (802) 855-8068

Other identifiers 2

IdentifierTypeStateIssuer
1018610MedicaidVT
4400791OtherVTMVP

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL backontrackpt.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110524000199 VT Practitioner - Physical Therapist in Private Practice 0749232957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Back on Track Physical Therapy PLLCGroup PAC ID 3274701164, 2 clinicians

Practice addresses (Care Compare)

365 US Route 4 E
Rutland, VT 05701-9035
Phone (802) 855-8068

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Back on Track Physical Therapy PLLC Physical Therapist CurrentSince Jul 5, 2011 Accepting new patients
Slate Valley Physical Therapy, Inc. Physical Therapist PastSince Oct 31, 2009 Accepting new patients
Therapeutic Life Center, Inc. Physical Therapist Past Accepting new patients

Locations

1 Scale Ave
Ste 32
Rutland, VT 05701
Phone (802) 558-4051

365 US Route 4 E
Rutland, VT 05701
Phone (802) 855-8068

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1992812549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 US ROUTE 4 E",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057019035",
            "telephone_number": "802-855-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 US ROUTE 4 E",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057019035",
            "telephone_number": "802-855-8068",
            "fax_number": "802-855-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSER",
        "first_name": "KATHRYN",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "MPT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "RI",
            "license": "PT02086",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "040.0072377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018610",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "4400791",
            "state": "VT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "backontrackpt.org",
            "affiliation": "N",
            "endpointDescription": "Physical Therapy Clinic",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "365 US Route 4 E",
            "city": "Rutland",
            "state": "VT",
            "country_code": "US",
            "postal_code": "057019035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rutland, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; 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.