Kelly L Dortch, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1192880 Issued in TX

Practice address

100 Wimbledon SQ
Chesapeake, VA 23320-4931

Phone

(757) 547-5145

Fax

(757) 436-2480

NPI assigned

Oct 19, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aquatic Physical Therapy and Beyond, LLCGroup PAC ID 2668450008, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24174/brand/1/csg/1/fhir/r4

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.

• Aquatic Physical Therapy & Beyond, LLC

  • Physical Therapist
  • Raleigh, NC
  • NPI 1861462558
  Medicare reassignment Care Compare group NPD
• Sports Medicine and Orthopaedic Center

  • Physical Therapist
  • Chesapeake, VA
  • NPI 1386303832
  NPD (past)

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

{
    "created_epoch": "1192752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1083803605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14703 EAGLE VISTA DR",
            "address_2": "BUILDING 601",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770775394",
            "telephone_number": "281-249-7103",
            "fax_number": "281-249-7194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WIMBLEDON SQ",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204931",
            "telephone_number": "757-547-5145",
            "fax_number": "757-436-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORTCH",
        "first_name": "KELLY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-19",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305205166",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1192880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "1192880",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA LICENSE",
            "identifier": "2305205166",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Donkle
• Mindal R. Donner, DC
• David G Dorbad, MD
• Amber Dorsey, LCSW
• Carlesha Dorsey, RPH
• Sabrina Dos Santos
• Vickie Lee Doscher, FNP
• Aleah Dotson, COTA/L
• Mary Jo Dougherty, PA - C
• Taylor Raye Doughtie, PSY.D., LCP

• Physical Therapist in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; 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.