Individual provider Active NPI

Cynthia Lynn Kelley, P.T.

  • Physical Therapist
  • Phoenix, AZ
National Provider Identifier
1568439636
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5741 Issued in AZ
Practice address
402 E Greenway Pkwy
Suite 12
Phoenix, AZ 85022-2350
Phone
(602) 789-6878
Fax
(602) 789-6708
NPI assigned
Mar 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 5741 AZ Primary

Addresses

Primary practice location

402 E Greenway Pkwy
Suite 12
Phoenix, AZ 85022-2350

Mailing address

5301 E Friess Dr
Scottsdale, AZ 85254-2913
Phone (602) 368-9047

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5741AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Vibrantcare Outpatient Rehabilitation West Inc Past Accepting new patients
Vibrantcare Outpatient Rehabilitation West Inc Past Accepting new patients

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": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568439636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 E FRIESS DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852542913",
            "telephone_number": "602-368-9047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 E GREENWAY PKWY",
            "address_2": "SUITE 12",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850222350",
            "telephone_number": "602-789-6878",
            "fax_number": "602-789-6708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "CYNTHIA",
        "middle_name": "LYNN",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "5741",
            "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 Jul 8, 2007; 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.