Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Kelly Gerrit Vredeveld, PT, DPT

Individual provider Physical Therapist · NPI 1588602874

Mr. Kelly Gerrit Vredeveld, PT, DPT is a Physical Therapist in Private Practice in Prescott Valley, Arizona. Qualified in 2002, 24 years ago. Practices with Canyon Physical Therapy and Aquatic Rehabilitation PLLC, a 4-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
24
Licensed in
AZ
In the registry since
2006
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

2852 N Navajo Dr Ste A
Prescott Valley, AZ 86314-4966
Phone: (928) 772-9797
Fax: (928) 772-9340
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 5810 (AZ)

Record details

NPI number1588602874
Entity typeIndividual (Type 1)
GenderMale
Credentials PT , DPT
Sole proprietorNo
NPI enumeratedJune 2, 2006
Last updated in NPPESJuly 10, 2024
Certification dateJuly 10, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Canyon Physical Therapy And Aquatic Rehabilitation Pllc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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