Ryan Kennelly, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA02030500 Issued in NJ

Practice address

525 E 71St St
New York, NY 10021-4828

Phone

(212) 606-1005

NPI assigned

Sep 15, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Jag-One Physical Therapy, LLC

  • Occupational Therapist
  • Chatham, NJ
  • NPI 1831660323
  NPD (past)

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

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1669142352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E 71ST ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214828",
            "telephone_number": "212-606-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 71ST ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214828",
            "telephone_number": "212-606-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNELLY",
        "first_name": "RYAN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-15",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02030500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kennellyr@hss.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "525 E 71st St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "525 E 71st St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "525 E 71st St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shannon Kennedy
• Symonne Kennedy, LCSW
• Thomas Michael Kennedy, MD
• Troy Lamar Kennedy III, M.D.
• Zomorah Kennedy
• Kenneth a Egol
• Kenneth Alper MD PC
• Kenneth Blank, M.D., P.C. (Allara Medical Group)
• Kenneth C Vitale MD, P.C.
• Kenneth C. Tam, M.D., F.a.C.C., P.C.

• Physical Therapist in New York, NY
• Providers in New York, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.