Active NPI
Lisa Kelley
- Physical Therapist
- Fenton, MO
National Provider Identifier
1376056903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01567
- Practice address
- 1 Arbor Ter
Fenton, MO 63026-3900 - Phone
- (636) 343-0016
- NPI assigned
- Nov 6, 2017
- 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 Therapist | 225100000X | 01567 | MO | Primary |
Addresses
Primary practice location
1 Arbor Ter
Fenton, MO 63026-3900
Mailing address
3383 Bradford LN
Arnold, MO 63010-3779
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 |
|---|---|---|---|
| 01567 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509926400000",
"number": "1376056903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3383 BRADFORD LN",
"city": "ARNOLD",
"state": "MO",
"postal_code": "630103779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 ARBOR TER",
"city": "FENTON",
"state": "MO",
"postal_code": "630263900",
"telephone_number": "636-343-0016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-06",
"last_updated": "2017-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "01567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.