Kurt R Neelly, P. T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070011538 Issued in IL

Practice address

209 N Cummings LN
Washington, IL 61571-2181

Phone

(309) 886-2305

Fax

(309) 444-3893

NPI assigned

Jan 15, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257379200000",
    "number": "1467503680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 N CUMMINGS LN",
            "city": "WASHINGTON",
            "state": "IL",
            "postal_code": "615712181",
            "telephone_number": "309-886-2305",
            "fax_number": "309-444-3893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 N CUMMINGS LN",
            "city": "WASHINGTON",
            "state": "IL",
            "postal_code": "615712181",
            "telephone_number": "309-886-2305",
            "fax_number": "309-444-3893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEELLY",
        "first_name": "KURT",
        "middle_name": "R",
        "credential": "P. T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2009-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070011538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL BLUE CROSS BLUE SHIELD",
            "identifier": "0029040291",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER ID",
            "identifier": "10759614",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lee Eugene Moore, DDS
• James C. Mosbach, D.C.
• Rita Ellen Mourisse, MA, CCC-SLP
• Martha J. Muller
• Marie L Mullins, LCPC, CDE
• Stephanie Nelson
• Next Step Training, LTD.
• Angela Faith Nieukirk, COTA
• Serge Fon Njigeh
• Donna Anne Noonan, PTA

• Physical Therapist in Washington, IL
• Providers in Washington, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2009; 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.