Individual provider Active NPI

Kelly J McLearran, PT

  • Physical Therapist
  • Oro Valley, AZ
National Provider Identifier
1528096179
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3289 Issued in AZ
Practice address
1617 W Placita Montuoso
Oro Valley, AZ 85737-3677
Phone
(520) 300-1634
Fax
(520) 797-3530
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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 3289 AZ Primary

Addresses

Primary practice location

1617 W Placita Montuoso
Oro Valley, AZ 85737-3677

Mailing address

1617 W Placita Montuoso
Oro Valley, AZ 85737-3677
Phone (520) 300-1634

Other identifiers 1

IdentifierTypeStateIssuer
548315MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120313000300 AZ Practitioner - Physical Therapist in Private Practice 8820257702 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3289AZMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Foothills Sports Medicine & Rehabilitation- Tucson, LLC Physical Therapist CurrentSince Dec 1, 2020 Accepting new patients
Straight 2U Physical Therapy CurrentSince Jul 8, 2020 Accepting new patients

Locations

15410 S Mountain Pkwy
Ste 112
Phoenix, AZ 85044
Phone (480) 609-0822

7575 W Twin Peaks Rd
Ste 155
Tucson, AZ 85743
Phone (520) 290-1665

Organizations & group practices 2

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1528096179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 W PLACITA MONTUOSO",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857373677",
            "telephone_number": "520-300-1634",
            "fax_number": "520-797-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 W PLACITA MONTUOSO",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857373677",
            "telephone_number": "520-300-1634",
            "fax_number": "520-797-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLEARRAN",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "3289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "548315",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oro Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.