Individual provider Active NPI

Cailyn Kennedy

  • Physical Therapist
  • Phoenix, AZ
National Provider Identifier
1548915762
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
LPT-32811 Issued in AZ
Practice address
2103 W Parkside LN Ste 103
Phoenix, AZ 85027-1245
Phone
(602) 675-0325
NPI assigned
Feb 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X LPT-32811 AZ Primary

Addresses

Primary practice location

2103 W Parkside LN Ste 103
Phoenix, AZ 85027-1245

Mailing address

2103 W Parkside LN Ste 103
Phoenix, AZ 85027-1245

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260210002812 CA Practitioner - Physical Therapist in Private Practice 6406242197 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4295 Gesner St
Suite 3C1
San Diego, CA 92117-6605

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Benchmark Physical Therapy of NC, LLC Physical Therapist CurrentSince Feb 15, 2022 Accepting new patients
Benchmark Physical Therapy of North Carolina LLC Physical Therapist CurrentSince Feb 15, 2022 Accepting new patients
The Physio Fix, PLLC Physical Therapist CurrentSince Sep 23, 2024 Accepting new patients
Foothills Sports Medicine & Rehabilitation, LLC Physical Therapist CurrentSince Feb 1, 2023 Accepting new patients
Foothills Sports Medicine & Rehabilitation, LLC CurrentSince Feb 1, 2023 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

19420 N 59th Ave
Ste H830
Glendale, AZ 85308
Phone (623) 302-9020

6788 S Kings Ranch Rd
Ste 4
Gold Canyon, AZ 85118
Phone (480) 982-1909

2103 W Parkside Ln
Ste 103
Phoenix, AZ 85027
Phone (602) 675-0325

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

3305 N Swan Rd
Ste 115
Tucson, AZ 85712
Phone (520) 321-0204

2230 Park Rd
Ste 104
Charlotte, NC 28203
Phone (704) 919-1280

10020 Monroe Rd
Ste 160
Matthews, NC 28105
Phone (704) 841-0894

Organizations & group practices 6

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": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1548915762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 W PARKSIDE LN STE 103",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850271245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 W PARKSIDE LN STE 103",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850271245",
            "telephone_number": "602-675-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CAILYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-32811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.