Kelly R Pepper, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12993PT Issued in AZ

Practice address

3201 W Peoria Ave Ste B408
Phoenix, AZ 85029-4610

Phone

(623) 322-0654

Fax

(623) 322-0664

NPI assigned

May 26, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Hudie Radich Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Legacy Healthcare Services Inc

  • Physical Therapist
  • Chandler, AZ
  • NPI 1336770221
  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489
  NPD
• Ideal Rehabilitation LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1831353614
  NPD (past)

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

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495756800000",
    "number": "1235667817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 W PEORIA AVE STE B408",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294610",
            "telephone_number": "623-322-0654",
            "fax_number": "623-322-0664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEPPER",
        "first_name": "KELLY",
        "middle_name": "R",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-26",
        "last_updated": "2017-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "12993PT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "RADICH",
            "middle_name": "HUDIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Selma Peper, M.S., CF-SLP
• Eric Pepin, CCP
• Albert Peter Pepka, M.D.
• Lisa Marie Pepka, M.D
• Dwayne Pepper, LMT
• Michiko Pepple, LPC, NCC
• William Peppo, DO
• Evan Tanner Perala
• Kimberly Perales Soto, AA, RBT
• Nydia Peralez, MA

• Physical Therapist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2017; 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.