Kelli S. Smith, PT
Individual provider Active NPI Physical Therapist · Bridgeport, TX
NPI 1154580983 · NPPES record last updated Dec 20, 2018
Key facts
- NPI
- 1154580983
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1180918 (TX)
- Practice address
- 1116 Halsell St
Bridgeport, TX 76426-3000 - Phone
- (940) 683-5575
- NPI assigned
- Jun 6, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Foundation Therapy LLC
Practice addresses (Care Compare)
1116 Halsell St
Bridgeport, TX 76426-3000
Phone (940) 393-5575
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190304002601 | TX | Practitioner - Physical Therapist in Private Practice | 6103165493 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1180918 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Foundation Therapy LLC | Current |
Accepting new patients |
Locations
1116 Halsell St
Bridgeport, TX 76426
Phone (940) 393-5575
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1180918 | TX | Yes |
Addresses
Primary practice location
1116 Halsell St
Bridgeport, TX 76426-3000
Mailing address
PO Box 1402
Bridgeport, TX 76426-1402
Phone (940) 683-5575
Other providers in Bridgeport, TX
- SCC Partners, Inc.
- SCC Partners, Inc.
- Dan C Selz
- Deborah Selz
- Emily Kathleen Smith
- Alissa Sobieraj
- Solaris Pharmacy Inc
- Southwest Healthcare Ventures
- Michaelyn Stainton
- Steve Longacre M.D. PA
All providers in Bridgeport, TX · Physical Therapist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.