Active NPI
Lynn W Kelly, PT, DPT
- Physical Therapist
- North Tonawanda, NY
National Provider Identifier
1063628402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6403-1
- Practice address
- 7258 Winbert Dr
North Tonawanda, NY 14120-1456 - Phone
- (716) 694-4179
- NPI assigned
- May 15, 2007
- Last updated
- Jul 31, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6403-1 | NY | Primary |
Addresses
Primary practice location
7258 Winbert Dr
North Tonawanda, NY 14120-1456
Mailing address
7258 Winbert Dr
North Tonawanda, NY 14120-1456
Phone (716) 694-4179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6403-1 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185840000000",
"number": "1063628402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7258 WINBERT DR",
"city": "NORTH TONAWANDA",
"state": "NY",
"postal_code": "141201456",
"telephone_number": "716-694-4179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7258 WINBERT DR",
"city": "NORTH TONAWANDA",
"state": "NY",
"postal_code": "141201456",
"telephone_number": "716-694-4179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "LYNN",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2007-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "6403-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Tonawanda, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.