Active NPI
Kelly L Purdue, PTA
- Physical Therapy Assistant
- Salem, IN
National Provider Identifier
1316766835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06005067A
- Practice address
- 911 N Shelby St
Salem, IN 47167-2304 - Phone
- (812) 883-8520
- Fax
- (812) 883-8598
- NPI assigned
- Oct 10, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 06005067A | IN | Primary |
Addresses
Primary practice location
911 N Shelby St
Salem, IN 47167-2304
Mailing address
911 N Shelby St
Salem, IN 47167-2304
Phone (812) 883-8520
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 |
|---|---|---|---|
| 06005067A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728518400000",
"number": "1316766835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "911 N SHELBY ST",
"city": "SALEM",
"state": "IN",
"postal_code": "471672304",
"telephone_number": "812-883-8520",
"fax_number": "812-883-8598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "911 N SHELBY ST",
"city": "SALEM",
"state": "IN",
"postal_code": "471672304",
"telephone_number": "812-883-8520",
"fax_number": "812-883-8598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PURDUE",
"first_name": "KELLY",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-10",
"last_updated": "2024-10-10",
"certification_date": "2024-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06005067A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.