Active NPI
Kelly Richards, PT
- Physical Therapist
- Bloomington, IL
National Provider Identifier
1649529009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.013855
- Practice address
- 2200 E. Washington St.
Bloomington, IL 61701 - Phone
- (309) 661-6260
- NPI assigned
- Aug 31, 2012
- 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 | 070.013855 | IL | Primary |
Addresses
Primary practice location
2200 E. Washington St.
Bloomington, IL 61701
Mailing address
1407 Godfrey Drive
Normal, IL 61761
Phone (309) 826-1771
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.013855 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346371200000",
"number": "1649529009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1407 GODFREY DRIVE",
"city": "NORMAL",
"state": "IL",
"postal_code": "61761",
"telephone_number": "309-826-1771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 E. WASHINGTON ST.",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "61701",
"telephone_number": "309-661-6260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDS",
"first_name": "KELLY",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-31",
"last_updated": "2012-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.013855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.