NPIMap

Individual provider Active NPI

Kelly J. Nixon, PT, DPT

  • Physical Therapist
  • Midlothian, VA
National Provider Identifier
1518329366
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305210073 Issued in VA
Practice address
2820 Waterford Lake Dr Ste 103
Midlothian, VA 23112-3994
Phone
(804) 249-8277
Fax
(804) 249-9690
NPI assigned
Mar 22, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT024390 PA
Physical Therapist 225100000X PT003484 WV
Physical Therapist 225100000X 2305210073 VA Primary

Addresses

Primary practice location

2820 Waterford Lake Dr Ste 103
Midlothian, VA 23112-3994

Mailing address

2820 Waterford Lake Dr Ste 103
Midlothian, VA 23112-3994
Phone (804) 249-8277

Other practice location 1

10438 Iron Bridge Rd
Chester, VA 23831-1427
Phone (800) 479-6151

Other identifiers 2

IdentifierTypeStateIssuer
C05954OtherVAMEDICARE GROUP PTAN
1518329366OtherVAMEDICAID QMB PROVIDER ID

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

LicenseStateTypeSpecialty
PT024390PAMDPhysical Therapist
PT003484WVMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist Past Accepting new patients
H2 Rehabilitation Services of Virginia LLC Past Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients
Tidewater Physical Therapy LLC Physical Therapist Past Accepting new patients

Organizations & group practices 7

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": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1518329366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 WATERFORD LAKE DR STE 103",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231123994",
            "telephone_number": "804-249-8277",
            "fax_number": "042-499-6908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 WATERFORD LAKE DR STE 103",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231123994",
            "telephone_number": "804-249-8277",
            "fax_number": "804-249-9690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10438 Iron Bridge Rd",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "VA",
            "postal_code": "238311427",
            "country_code": "US",
            "telephone_number": "800-479-6151",
            "fax_number": "804-796-1543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIXON",
        "first_name": "KELLY",
        "middle_name": "J.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-22",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT024390",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "PT003484",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305210073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "C05954",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID QMB PROVIDER ID",
            "identifier": "1518329366",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midlothian, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.