Kelly Cicerello, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1062669 Issued in TX

Practice address

2301 Ohio Dr
Suite 133
Plano, TX 75093-3927

Phone

(972) 398-7881

Fax

(972) 398-7884

NPI assigned

Sep 30, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Theriault Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317340800000",
    "number": "1619251253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 N I-35",
            "address_2": "SUITE 110",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762073432",
            "telephone_number": "940-483-9020",
            "fax_number": "940-483-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 OHIO DR",
            "address_2": "SUITE 133",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750933927",
            "telephone_number": "972-398-7881",
            "fax_number": "972-398-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICERELLO",
        "first_name": "KELLY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-30",
        "last_updated": "2011-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1062669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "THERIAULT",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Greg Cigainero, PHARMD, BCPS
• Cindy C. Hartley, MD, PA
• Julia Cinquepalmi, M.ED., LPC
• Dean A Cione, M.D., F.A.C.S
• Citron Telecare LLC

• Physical Therapist in Plano, TX
• Providers in Plano, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; 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.