Active NPI
Kelly King
- Pediatric Physical Therapist
- Mesa, AZ
National Provider Identifier
1164649406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1441
- Practice address
- 952 E Baseline Rd
Suite A106
Mesa, AZ 85204-6627 - Phone
- (480) 926-6309
- NPI assigned
- Apr 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1441 | AZ | Primary |
Addresses
Primary practice location
952 E Baseline Rd
Suite A106
Mesa, AZ 85204-6627
Mailing address
952 E Baseline Rd
Suite A106
Mesa, AZ 85204-6627
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1441 | AZ | MD | Optometrist |
Interoperability endpoints
- kelly.king.1@5919.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164649406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "952 E BASELINE RD",
"address_2": "SUITE A106",
"city": "MESA",
"state": "AZ",
"postal_code": "852046627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "952 E BASELINE RD",
"address_2": "SUITE A106",
"city": "MESA",
"state": "AZ",
"postal_code": "852046627",
"telephone_number": "480-926-6309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "AZ",
"license": "1441",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.