Kelly Elaine Fodo, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

014026 Issued in OH

Practice address

27511 Holiday LN Ste 105
Perrysburg, OH 43551-5397

Phone

(419) 873-3488

Fax

(419) 873-4777

NPI assigned

Apr 19, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Elaine Burgard Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1366329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444953600000",
    "number": "1235573346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27511 HOLIDAY LN STE 105",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515397",
            "telephone_number": "419-873-3488",
            "fax_number": "419-873-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27511 HOLIDAY LN STE 105",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435515397",
            "telephone_number": "419-873-3488",
            "fax_number": "419-873-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FODO",
        "first_name": "KELLY",
        "middle_name": "ELAINE",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-19",
        "last_updated": "2015-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "014026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "BURGARD",
            "middle_name": "ELAINE",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Perrysburg, OH
• Providers in Perrysburg, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.