Kelly Peck, MPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT22097 Issued in CA

Practice address

1835 S Sepulveda Blvd
Los Angeles, CA 90025-4313

Phone

(310) 478-6222

Fax

(310) 478-6696

NPI assigned

Apr 2, 2009

Last updated

Apr 2, 2009By the provider in NPPES

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• The Sportsmed Company

  • Physical Therapy Clinic/Center
  • Los Angeles, CA
  • NPI 1356439996
  NPD (past)
• The Sportsmed Company

  dba SportsMed OC

  • Physical Therapy Clinic/Center
  • Irvine, CA
  • NPI 1538210083
  NPD (past)

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

{
    "created_epoch": "1238630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238630400000",
    "number": "1316189566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27023 TIMBERLINE TER",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913810623",
            "telephone_number": "213-309-5767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 S SEPULVEDA BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900254313",
            "telephone_number": "310-478-6222",
            "fax_number": "310-478-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "KELLY",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-02",
        "last_updated": "2009-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "PT22097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA PHYSICAL THERAPY LICENSE",
            "identifier": "PT22097",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katy Stenton Peck-Frost, CCC-SLP
• Regina C Peck-Sobolewski, MA
• Alexander Robert Peck, DO
• Arthur W Peck, DDS
• Kaitlyn Peck
• Michael L Peck, PHD
• Sarah Peck, RN, IBCLC
• Natalia Peczkowska, PSYD
• Ryan C Ped, NP
• Pirayeh Pedarsani, RD, RD

• Pediatric Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatric Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.