Individual provider Active NPI

Kelly West, PT, DPT

  • Physical Therapist
  • Evans, GA
National Provider Identifier
1285299883
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT009991 Issued in GA
Practice address
3949 Evans to Locks Rd
Evans, GA 30809-8054
Phone
(706) 396-9255
NPI assigned
May 8, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT009991 GA Primary

Addresses

Primary practice location

3949 Evans to Locks Rd
Evans, GA 30809-8054

Mailing address

221 Dixon CT
Evans, GA 30809-4302

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200409003336 GA Practitioner - Physical Therapist in Private Practice 4486083581 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services, Inc. Physical Therapist CurrentSince Mar 10, 2020 Accepting new patients
Legacy Healthcare Services Inc Physical Therapist CurrentSince Mar 10, 2020 Accepting new patients
Functional Pathways Preferred of Tennessee LLC Physical Therapist CurrentSince Jun 30, 2020 Accepting new patients
Southeastern Swallowing Diagnostics Physical Therapist CurrentSince Dec 1, 2020 Accepting new patients

Locations

100 Washington Commons Dr
Evans, GA 30809
Phone (706) 426-8136

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

10133 Sherrill Blvd
Ste 200
Knoxville, TN 37932
Phone (865) 392-2847

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1285299883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 DIXON CT",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3949 EVANS TO LOCKS RD",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308098054",
            "telephone_number": "706-396-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEST",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-08",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT009991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; 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.