Kyle Kelly, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA.0015529 Issued in CO

Practice address

590 Burbank St Unit 205
Broomfield, CO 80020-7171

Phone

(303) 460-0329

Fax

(303) 460-0387

NPI assigned

Jul 15, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Anchor Physical Therapy, P.C.

  • Physical Therapy Clinic/Center
  • Broomfield, CO
  • NPI 1689756801
  NPD

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

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1295572303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 BURBANK ST UNIT 205",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800207171",
            "telephone_number": "303-460-0329",
            "fax_number": "303-460-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 BURBANK ST UNIT 205",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800207171",
            "telephone_number": "303-460-0329",
            "fax_number": "303-460-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KYLE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CO",
            "license": "PTA.0015529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO SATE LICENSE",
            "identifier": "PTA.0015529",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Katsirubas, PT
• Julie Kay, L.AC., C.H.
• Harue Ishii Keim, MA
• Julianne M Keith, DPT
• Britni Keitz
• Emily Kempf
• Tracy Kenline, LCSW
• Kevala Kenna
• Lisa Kennedy, LMFT
• Keri Beth Kenning, DDS MSD

• Physical Therapy Assistant in Broomfield, CO
• Providers in Broomfield, CO by specialty
• Physical Therapy Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.