Justin T Kelly, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT5375 Issued in NM

Practice address

2404 S Locust St Ste 5
Las Cruces, NM 88001-5789

Phone

(575) 521-4188

Fax

(575) 521-3668

NPI assigned

Nov 1, 2018

Reactivated

Nov 16, 2018

Last updated

Nov 16, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Real View Diagnostics LLC

  • Physical Therapist
  • Canutillo, TX
  • NPI 1336882026
  NPD (past)

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

{
    "created_epoch": "1541030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542326400000",
    "number": "1548737091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 S LOCUST ST STE 5",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880015789",
            "telephone_number": "575-521-4188",
            "fax_number": "575-521-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 S LOCUST ST STE 5",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880015789",
            "telephone_number": "575-521-4188",
            "fax_number": "575-521-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JUSTIN",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-01",
        "last_updated": "2018-11-16",
        "deactivation_date": "2018-11-01",
        "reactivation_date": "2018-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "PT5375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Benjamin Keller
• John Wesley Kelley
• Ainsley Kelly
• Deborah Kelly, MSN, RN, PMHNP
• Erin N Kelly
• Sariyah Kelly
• Stuart S Kelter, PSY.D.
• Catherine T. Kemmer, M.D.
• Alexis Kemp
• Cheri Kemp, MA/LPCC

• Physical Therapist in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; 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.