Active NPI
Kelly M Mudlo
- Physical Therapist
- Monterey, CA
National Provider Identifier
1265931554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 293843
- Practice address
- 1575 Skyline Dr
Monterey, CA 93940-4110 - Phone
- (831) 373-2371
- NPI assigned
- Feb 1, 2018
- Last updated
- Feb 1, 2018
- 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 Therapist | 225100000X | 293843 | CA | Primary |
Addresses
Primary practice location
1575 Skyline Dr
Monterey, CA 93940-4110
Mailing address
5542 S Cedar St
Littleton, CO 80120-1310
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 293843 | CA | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trellis Physical Therapy a Professional Rehab Group Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Los Angeles, CA
- NPI 1730245838
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517443200000",
"number": "1265931554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5542 S CEDAR ST",
"city": "LITTLETON",
"state": "CO",
"postal_code": "801201310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1575 SKYLINE DR",
"city": "MONTEREY",
"state": "CA",
"postal_code": "939404110",
"telephone_number": "831-373-2371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUDLO",
"first_name": "KELLY",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-01",
"last_updated": "2018-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "293843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monterey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.