Mary Kelly, PT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

070-011761 Issued in IL

Practice address

3381 W Main St Ste 1
St Charles, IL 60175-1008

Phone

(630) 549-0511

Fax

(630) 549-0512

NPI assigned

Dec 29, 2005

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

• Mary Jeffries Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fox Valley Physical Therapy and Wellness,LLCGroup PAC ID 2769677608, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Fox Valley Physical Therapy and Wellness,LLC

  • Physical Therapist
  • Saint Charles, IL
  • NPI 1619288966

  Pediatrics

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1073590212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3381 W MAIN ST STE 1",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601751008",
            "telephone_number": "630-549-0511",
            "fax_number": "630-549-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3381 W MAIN ST STE 1",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601751008",
            "telephone_number": "630-549-0511",
            "fax_number": "630-549-0512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MARY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-29",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "IL",
            "license": "070-011761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "JEFFRIES",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edmund M Kearney, PH.D.
• Lisa Kearney
• Albert Richard Keating, PH.D., LCPC
• Courtney Kelly, BCBA
• Daniel Martin Kelly, D.M.D.
• Margaret Kempff
• Emily Kendall, LCPC
• Kerry Kendall
• Katelyn Mary Kendziora
• Kenneth a Noffsinger MD LTD

• Pediatric Physical Therapist in St Charles, IL
• Providers in St Charles, IL by specialty
• Pediatric Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.