Active NPI
Alyssa Dawn Kelly, LPTA
- Physical Therapy Assistant
- Lake Jackson, TX
National Provider Identifier
1255953402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2067876
- Practice address
- 204 Oak Dr S
Lake Jackson, TX 77566-5628 - Phone
- (979) 297-0425
- NPI assigned
- May 11, 2020
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2067876 | TX | Primary |
Addresses
Primary practice location
204 Oak Dr S
Lake Jackson, TX 77566-5628
Mailing address
957 Mill Rd
Angleton, TX 77515-9128
Phone (832) 215-0757
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 |
|---|---|---|---|
| 2067876 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589155200000",
"number": "1255953402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "957 MILL RD",
"city": "ANGLETON",
"state": "TX",
"postal_code": "775159128",
"telephone_number": "832-215-0757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 OAK DR S",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775665628",
"telephone_number": "979-297-0425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ALYSSA",
"middle_name": "DAWN",
"credential": "LPTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-11",
"last_updated": "2020-05-11",
"certification_date": "2020-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2067876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Jackson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.