Kenny A De Luca, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT2475 Issued in AR

Practice address

9843 Maumelle Blvd
North Little Rock, AR 72113-7027

Phone

(501) 753-2201

Fax

(501) 753-2207

NPI assigned

Nov 30, 2005

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Maumelle Physical Therapy

  • Physical Therapist
  • North Little Rock, AR
  • NPI 1730163072
  Medicare reassignment NPD Authorized official
• Alternative Medical Arts

  • Clinic/Center
  • Conway, AR
  • NPI 1336361609
  NPD (past)
• Conway Chiropractic & Wellness Center

  • Chiropractor
  • Conway, AR
  • NPI 1780960443
  NPD (past)

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1114901451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13567",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721130567",
            "telephone_number": "501-753-2201",
            "fax_number": "501-753-2207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9843 MAUMELLE BLVD",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721137027",
            "telephone_number": "501-753-2201",
            "fax_number": "501-753-2207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LUCA",
        "first_name": "KENNY",
        "middle_name": "A",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT2475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BCBS GROUP",
            "identifier": "5F332",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BCBS INDIVIDUAL",
            "identifier": "5W795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Catherine Yates Davison, LCSW
• Dawson J Williams
• Bradley Scott Dawson
• Bruce Edward Dawson Jr.
• Jose G De la Rosa, D.C.
• Beatriz De Mattos
• Deborah B. Deacon, L.C.S.W.
• Brandy Michelle Dean, PSY.D.
• John Hamilton Dean, D.D.S.
• Rebecca L. Dearworth, M.S., CCC-SLP

• Physical Therapist in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.