Legacy Beach Therapies LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

LEGACY BEACH THERAPIES LLC

Practice address

202 N Main St
Nolanville, TX 76559-4349

Phone

(254) 624-6786

NPI assigned

Oct 28, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Joel Thomas Kelley, DPTNPI 1750851713

Title

Owner/Physical Therapist

Phone

(254) 493-0648

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joel Kelley

  • Physical Therapist
  • Harker Heights, TX
  • NPI 1750851713
  Medicare reassignment Care Compare group NPD Authorized official
• Kayla Kelley, OTR

  • Pediatric Occupational Therapist
  • Nolanville, TX
  • NPI 1477815470
  Medicare reassignment Care Compare group NPD
• Anne Rehler Vincent, PT, DPT

  • Physical Therapist
  • Georgetown, TX
  • NPI 1679249510
  Medicare reassignment NPD
• Jordan Vincent, PT, DPT

  • Physical Therapist
  • Pasadena, TX
  • NPI 1154005510
  Medicare reassignment NPD
• Philip Cagle

  • Physical Therapist
  • Nolanville, TX
  • NPI 1740131556
  NPD (past)

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

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1417664541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8631 CEDAR CREEK RD",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765046144",
            "telephone_number": "254-493-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 N MAIN ST",
            "city": "NOLANVILLE",
            "state": "TX",
            "postal_code": "765594349",
            "telephone_number": "254-624-6786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8631 Cedar Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Temple",
            "state": "TX",
            "postal_code": "765046144",
            "country_code": "US",
            "telephone_number": "254-493-0648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEGACY BEACH THERAPIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-28",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "254-493-0648",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Harkness
• Lavern Humphries
• Edith Carolina Keenly, LPC
• Kayla Kelley, OTR
• Joseph Michael Lansing, LVN
• Tracy Dorinda Lemley
• Lisa J. Morales, LPC, PLLC
• Elis Lashan McBride, MS
• Lisa J Morales, LPC
• Britley Nicole Myers

• Physical Therapy Clinic/Center in Nolanville, TX
• Providers in Nolanville, TX by specialty
• Physical Therapy Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.