Kelly Johnson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

307143 Issued in CA

Practice address

25381 Railroad Canyon Rd
Lake Elsinore, CA 92532-2705

Phone

(951) 244-8404

NPI assigned

Dec 9, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Kaufman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Fairbanks & Power Physical Therapy Corp.

  dba PacificPro Physical Therapy & Sports Medicine

  • Physical Therapist
  • Irvine, CA
  • NPI 1912953936
  NPD

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

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1023824661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19408 STERLING HILL LN",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925706587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25381 RAILROAD CANYON RD",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925322705",
            "telephone_number": "951-244-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-09",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "307143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "KAUFMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jana Tran D.D.S. Inc.
• Allen Jimenez
• Shannon Lee Jinjoe
• Mery Joharzadeh
• Jasmine J Johnson
• Ottis Johnson, C.A.S.
• Hannah Jean Jones, PMHNP-BC
• Jennifer June Jones, NA
• Judith A Jones, MFTI
• Caitlin Jordan, BIRTH DOULA

• Physical Therapist in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.