Derek Kelly, PT/AOP

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

14094 Issued in NC

Practice address

3800 Shamrock Dr
Charlotte, NC 28215-3220

Phone

(704) 532-5462

Fax

(704) 532-5387

NPI assigned

Nov 7, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1043649239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4833 MEADOWRIDGE DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282261214",
            "telephone_number": "704-999-4734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 SHAMROCK DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282153220",
            "telephone_number": "704-532-5462",
            "fax_number": "704-532-5387"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2675 Court Dr",
            "address_purpose": "LOCATION",
            "city": "Gastonia",
            "state": "NC",
            "postal_code": "280541478",
            "country_code": "US",
            "telephone_number": "704-824-7800",
            "fax_number": "704-824-2853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "DEREK",
        "credential": "PT/AOP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "14094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Denise Kelly, PHARMD
• Aubrey Kelly
• Barbara Sorrels Kelly, CRNA
• Daniel L Kelly, MD
• Daniel Rory Kelly, MD
• Dominique Kelly
• Ellen Elizabeth Kelly, PA
• Hope Ann Kelly, LPC
• Joseph Kelly
• Karyn Kelly, BCBA

• Physical Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.