Timothy David Kelly

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1168068 Issued in TX

Practice address

1404 11TH PL
Shallowater, TX 79363-5139

Phone

(806) 281-7550

NPI assigned

Jun 29, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Therapy Tech Contractors, PLLC

  • Home Health Agency
  • Shallowater, TX
  • NPI 1184481392
  NPD Authorized official

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1124382684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 11TH PL",
            "city": "SHALLOWATER",
            "state": "TX",
            "postal_code": "793635139",
            "telephone_number": "806-281-7550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 11TH PL",
            "city": "SHALLOWATER",
            "state": "TX",
            "postal_code": "793635139",
            "telephone_number": "806-281-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TIMOTHY",
        "middle_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-29",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1168068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Gillson, OT
• Annie Ellesa Hall-Gailey, CCC-SLP
• Kristy Jane Harrist, LPC-I
• Honda Ssa
• Stacy Jerome
• Kriss Teen Morrow, FNP-BC
• Randy C. Ray, RPH
• Rural Health Education
• Shallowater Isd
• Shallowater Pharmacy, LLC

• All providers in Shallowater, TX
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.