NPIMap

Individual provider Active NPI

Kelly Bewley, PTA

  • Physical Therapy Clinic/Center
  • Omaha, NE
National Provider Identifier
1083003628
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1200 Issued in NE
Practice address
10730 Pacific St Ste 210
Omaha, NE 68114-4761
Phone
(402) 753-7230
NPI assigned
Jan 20, 2015
Last updated
Jan 20, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 1200 NE Primary

Addresses

Primary practice location

10730 Pacific St Ste 210
Omaha, NE 68114-4761

Mailing address

720 Boulevard St Lot 4
Fremont, NE 68025-8652
Phone (402) 277-0637

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1200NEMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Medlink Companion, LLC PastSince Jan 1, 2012 Accepting new patients
Medlink, LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421712000000",
    "number": "1083003628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 BOULEVARD ST LOT 4",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680258652",
            "telephone_number": "402-277-0637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 PACIFIC ST STE 210",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681144761",
            "telephone_number": "402-753-7230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEWLEY",
        "first_name": "KELLY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NE",
            "license": "1200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; 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.