Kelly Gerrit Vredeveld, PT, DPT
NPI 1588602874ActiveIndividual· Physical Therapist· Prescott Valley, AZ
Physical Therapist (PT, DPT) with Canyon Physical Therapy and Aquatic Rehabilitation PLLC, practicing in Prescott Valley, Arizona. Medicare paid $139,962 for services to 216 patients in 2024.
Overview
| NPI | 1588602874 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PT, DPT |
| Sole proprietor | No |
| NPI issued | Jun 2, 2006 |
| Last updated in NPPES | Jul 10, 2024 |
| Certified by provider | Jul 10, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 5810 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (AZ) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 216 |
|---|---|
| Services billed | 7,424 across 14 procedure codes |
| Paid by Medicare | $139,962 |
Education and affiliations
| Graduation year | 2002 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical group
- Canyon Physical Therapy and Aquatic Rehabilitation PLLCPrescott Valley, AZ · 4 clinicians
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