Kelly L. Domeyer, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1342 Issued in OR

Practice address

3270 Liberty Rd. S.
Salem, OR 97302

Phone

(503) 371-0779

Fax

(503) 371-0886

NPI assigned

Dec 5, 2005

Last updated

Aug 5, 2020By the provider in NPPES

Sex

Female

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 1

Other names 1

• Kelly Brendle Former name

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Rehabilitation Associates IncGroup PAC ID 5991753592, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Northwest Rehabilitation Associates, Inc.

  • Physical Therapy Clinic/Center
  • West Salem, OR
  • NPI 1972505790

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• BPM Physical Therapy Center Inc

  • Physical Therapy Clinic/Center
  • Salem, OR
  • NPI 1245390004
  NPD (past)
• Physical Therapy Northwest Limited Partnership

  • Rehabilitation Clinic/Center
  • Stayton, OR
  • NPI 1255843355

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1487638276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3270 LIBERTY RD. S.",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-371-0779",
            "fax_number": "503-371-0886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3270 LIBERTY RD. S.",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-371-0779",
            "fax_number": "503-371-0886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2521 Boone Rd SE Ste 100",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973069391",
            "country_code": "US",
            "telephone_number": "503-585-5131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMEYER",
        "first_name": "KELLY",
        "middle_name": "L.",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "1342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023002",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "BRENDLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lori Jean Doede, MAC, LPC
• Amy Marie Doerfler
• Lisa Dianne Doherty, RN, BSN
• Kimberly Dolan, PSS
• Mark M Dolan, M.D.
• Leslie Domeyer
• Dashamir Domi, RDH
• Omar Dominguez Pascasio
• Maria Dominguez-Gonzalez
• Heidi Lynn Donahue

• Physical Therapist in Salem, OR
• Providers in Salem, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.