Kelly Roxanne Edwards, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT14613 Issued in CA

Practice address

1150 W Morton Ave Ste B
Porterville, CA 93257

Phone

(559) 782-1501

Fax

(559) 782-8528

NPI assigned

Feb 5, 2007

Last updated

Apr 9, 2019By 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 names 1

• Ms. Kelly Roxanne Gibson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1346389483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W CENTER AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916015",
            "telephone_number": "559-713-6806",
            "fax_number": "559-713-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 W MORTON AVE STE B",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "93257",
            "telephone_number": "559-782-1501",
            "fax_number": "559-782-8528"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 N D St",
            "address_purpose": "LOCATION",
            "city": "Porterville",
            "state": "CA",
            "postal_code": "932573621",
            "country_code": "US",
            "telephone_number": "559-783-0515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "KELLY",
        "middle_name": "ROXANNE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "GIBSON",
            "middle_name": "ROXANNE",
            "prefix": "MS.",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Raj H Dwivedi, MD
• Dycora Transitional Health & Living -- Porterville LLC
• Earl S Pearson MD Inc
• Michael J Ebaugh, MD
• Miranda Edmonds
• Lisa M Edwards, PT
• Zaida Loraine Elias, AA, BA, QABAT
• Elif Tokcan MD Inc
• Mark A Eller, M.D.
• Yusra Eltahir, DDS

• Physical Therapist in Porterville, CA
• Providers in Porterville, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; 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.