Active NPI
Timothy Michael Kelly, Jr., RPT
- Physical Therapist
- Providence, RI
National Provider Identifier
1437354529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1484
- Practice address
- 655 Broad St
Providence, RI 02907-1444 - Phone
- (401) 521-2214
- Fax
- (401) 861-4047
- NPI assigned
- Jun 19, 2007
- 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 | 1484 | RI | Primary |
Addresses
Primary practice location
655 Broad St
Providence, RI 02907-1444
Mailing address
143 Spofford Ave
Warwick, RI 02888-1816
Phone (401) 270-6033
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1484 | RI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437354529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "143 SPOFFORD AVE",
"city": "WARWICK",
"state": "RI",
"postal_code": "028881816",
"telephone_number": "401-270-6033",
"fax_number": "401-861-4047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 BROAD ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029071444",
"telephone_number": "401-521-2214",
"fax_number": "401-861-4047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY, JR.",
"first_name": "TIMOTHY",
"middle_name": "MICHAEL",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "RI",
"license": "1484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.