Active NPI
Matthew Davis Kennedy, PT
- Physical Therapist
- Saint Louis, MO
National Provider Identifier
1669614814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2010041904
- Practice address
- 3200 Chouteau Ave
Saint Louis, MO 63103-2910 - Phone
- (314) 977-1250
- NPI assigned
- Apr 2, 2009
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8419 | AZ | |
| Physical Therapist | 225100000X | 2010041904 | MO | Primary |
Addresses
Primary practice location
3200 Chouteau Ave
Saint Louis, MO 63103-2910
Mailing address
3200 Chouteau Ave
Saint Louis, MO 63103-2910
Phone (314) 977-1250
Other practice location 1
6677 W Thunderbird Rd
Suite C-142
Glendale, AZ 85306-3709
Phone (480) 222-0655
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 |
|---|---|---|---|
| 2010041904 | MO | MD | Physical Therapist |
| 8419 | AZ | MD | Child Mental Illness Respite Care |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ideal Rehabilitation LLC | Past | Accepting new patients | |
| Ati Holdings of Arizona, LLC | Physical Therapist | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Durable Medical Equipment & Medical Supplies
- Tucson, AZ
- NPI 1831353614
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1669614814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 CHOUTEAU AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631032910",
"telephone_number": "314-977-1250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 CHOUTEAU AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631032910",
"telephone_number": "314-977-1250"
}
],
"practiceLocations": [
{
"address_1": "6677 W Thunderbird Rd",
"address_2": "Suite C-142",
"address_purpose": "LOCATION",
"city": "Glendale",
"state": "AZ",
"postal_code": "853063709",
"country_code": "US",
"telephone_number": "480-222-0655",
"fax_number": "480-222-1457",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KENNEDY",
"first_name": "MATTHEW",
"middle_name": "DAVIS",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "8419",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2010041904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.