Active NPI
William Frederick Kelly, PT
- Physical Therapist
- Bridgeton, MO
National Provider Identifier
1336456466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2001013123
- Practice address
- 12266 Depaul Dr.
Suite 115
Bridgeton, MO 63044 - Phone
- (314) 209-7700
- Fax
- (314) 209-7705
- NPI assigned
- Sep 10, 2010
- Sex
- Male
- 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 Therapist | 225100000X | 2001013123 | MO | Primary |
Addresses
Primary practice location
12266 Depaul Dr.
Suite 115
Bridgeton, MO 63044
Mailing address
12266 Depaul Dr.
Suite 115
Bridgeton, MO 63044
Phone (314) 209-7700
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 |
|---|---|---|---|
| 2001013123 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284076800000",
"number": "1336456466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12266 DEPAUL DR.",
"address_2": "SUITE 115",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "63044",
"telephone_number": "314-209-7700",
"fax_number": "314-209-7705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12266 DEPAUL DR.",
"address_2": "SUITE 115",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "63044",
"telephone_number": "314-209-7700",
"fax_number": "314-209-7705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "WILLIAM",
"middle_name": "FREDERICK",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-10",
"last_updated": "2010-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2001013123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.