Kelly B Matus, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT02365 Issued in RI

Practice address

225 Chapman St
Providence, RI 02905-4533

Phone

(401) 490-7610

NPI assigned

Jan 19, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kelly B Campbell 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": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326931200000",
    "number": "1376814509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 RIVER FARM DR",
            "city": "EAST GREENWICH",
            "state": "RI",
            "postal_code": "028182145",
            "telephone_number": "401-398-7894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CHAPMAN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054533",
            "telephone_number": "401-490-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATUS",
        "first_name": "KELLY",
        "middle_name": "B",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-19",
        "last_updated": "2012-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "RI",
            "license": "PT02365",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "012882",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "CAMPBELL",
            "middle_name": "B",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emily Matthews
• Jon Mattingly, LMT
• Mark E. Mattingly, M.D.
• Eduardo Felipe Matto, M.D.
• Holly Marie Mattoes, PHARM.D.
• Robert Matuszek
• Jennifer L Maude, MD
• Maxi Drug South LP
• Maxi Drug South LP
• Maxi Drug South LP

• Physical Therapist in Providence, RI
• Providers in Providence, RI by specialty
• Physical Therapist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; 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.