Active NPI
Jennifer Kelley, MPT
- Physical Therapist
- Davidson, NC
National Provider Identifier
1588145304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P11141
- Practice address
- 825 Peninsula Dr
Davidson, NC 28036-7302 - Phone
- (615) 945-7320
- NPI assigned
- Aug 29, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P11141 | NC | Primary |
Addresses
Primary practice location
825 Peninsula Dr
Davidson, NC 28036-7302
Mailing address
13300 Willow Breeze LN
Huntersville, NC 28078-9629
Phone (615) 945-7320
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
| License | State | Type | Specialty |
|---|---|---|---|
| P11141 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535500800000",
"number": "1588145304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13300 WILLOW BREEZE LN",
"city": "HUNTERSVILLE",
"state": "NC",
"postal_code": "280789629",
"telephone_number": "615-945-7320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 PENINSULA DR",
"city": "DAVIDSON",
"state": "NC",
"postal_code": "280367302",
"telephone_number": "615-945-7320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-29",
"last_updated": "2018-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P11141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davidson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.