NPIMap

Individual provider Active NPI

Kelly Marie Dykstra, DPT

  • Physical Therapist
  • Chandler, AZ
National Provider Identifier
1467528653
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6132 Issued in AZ
Practice address
3310 E Canary Way
Chandler, AZ 85286
Phone
(480) 813-1897
Fax
(480) 361-9838
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6132 AZ Primary

Addresses

Primary practice location

3310 E Canary Way
Chandler, AZ 85286

Mailing address

3310 E Canary Way
Chandler, AZ 85286-5682
Phone (480) 813-1897

Other practice location 1

2220 S Country Club #104
Mesa, AZ 85210
Phone (480) 820-6366

Other names 1

  • Kelly Marie Long Other name

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

LicenseStateTypeSpecialty
6132AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
East Valley Speech Pathology Assoc LLC Past Accepting new patients
Advanced Therapy Solutions, LLC Past Accepting new patients
Making Milestones, PLLC Physical Therapist PastSince Sep 1, 2019 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1467528653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 E CANARY WAY",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852865682",
            "telephone_number": "480-813-1897",
            "fax_number": "480-361-9838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 E CANARY WAY",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85286",
            "telephone_number": "480-813-1897",
            "fax_number": "480-361-9838"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2220 S Country Club #104",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "85210",
            "country_code": "US",
            "telephone_number": "480-820-6366",
            "fax_number": "480-820-0462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "6132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "LONG",
            "middle_name": "MARIE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; 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.