NPIMap

Organization Active NPI

Kelly Fountain, M.S., L.P.T., L.L.C.

  • Counselor
  • Mobile, AL
National Provider Identifier
1154714384
Registry record updated Mar 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
1586 Issued in AL
Legal business name
KELLY FOUNTAIN, M.S., L.P.T., L.L.C.
Practice address
2864 Dauphin St
Suite a
Mobile, AL 36606-2479
Phone
(251) 470-7607
NPI assigned
Mar 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2015

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

Authorized official

Name
Kelly Fountain, MS, LPT
Title
Owner
Phone
(251) 470-7607

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101Y00000X 1586 AL Primary

Addresses

Primary practice location

2864 Dauphin St
Suite a
Mobile, AL 36606-2479

Mailing address

2864 Dauphin St
Suite a
Mobile, AL 36606-2479

Other identifiers 2

IdentifierTypeStateIssuer
1003148487OtherALNPI
511-33704OtherALBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1426118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1154714384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2864 DAUPHIN ST",
            "address_2": "SUITE A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366062479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2864 DAUPHIN ST",
            "address_2": "SUITE A",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366062479",
            "telephone_number": "251-470-7607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY FOUNTAIN, M.S., L.P.T., L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-12",
        "last_updated": "2015-03-12",
        "status": "A",
        "authorized_official_last_name": "FOUNTAIN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-470-7607",
        "authorized_official_credential": "MS, LPT"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "AL",
            "license": "1586",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1003148487",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "511-33704",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.