Individual provider Active NPI

Kelly D Sykes, PT

  • Physical Therapist
  • Columbia, MD
National Provider Identifier
1164555793
Registry record updated Sep 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
18546 Issued in MD
Practice address
10200 Old Columbia Rd Ste C
Columbia, MD 21046-2364
Phone
(410) 290-4480
Fax
(855) 300-3999
NPI assigned
Mar 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 18546 MD Primary

Addresses

Primary practice location

10200 Old Columbia Rd Ste C
Columbia, MD 21046-2364

Mailing address

10200 Old Columbia Rd Ste C
Columbia, MD 21046-2364
Phone (410) 290-4480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110104000036 MD Practitioner - Physical Therapist in Private Practice 7719175082

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sports and Orthopedic Therapy Services LLC Physical Therapist Past Accepting new patients
Robert C Grossman & Assoc PA Physical Therapist Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725235200000",
    "number": "1164555793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 OLD COLUMBIA RD STE C",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210462364",
            "telephone_number": "410-290-4480",
            "fax_number": "855-300-3999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 OLD COLUMBIA RD STE C",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210462364",
            "telephone_number": "410-290-4480",
            "fax_number": "855-300-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYKES",
        "first_name": "KELLY",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2024-09-02",
        "certification_date": "2024-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "18546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.