Glen Aaron Kelly

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A4734 Issued in NC

Practice address

3802 Wade Coble Dr
Burlington, NC 27215-9765

Phone

(336) 538-1522

NPI assigned

Mar 26, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1679323299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 WAGONER RD",
            "city": "ELON",
            "state": "NC",
            "postal_code": "272449222",
            "telephone_number": "919-423-7985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 WADE COBLE DR",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272159765",
            "telephone_number": "336-538-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "GLEN",
        "middle_name": "AARON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "A4734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charanpreet Kaur, FNP-C
• Jeremiah Keene
• Keith B. Nice, OD, PLLC
• Keith B. Nice, OD, PLLC
• Jorjanna Lee Kelley, PHARMD, CGP
• Mark Windsor Kemp, DDS
• Deborah June Kennerson-Webb
• William K Kephart, MD
• Madison Lee Kernick, DDS
• Kernodle Clinic, Inc

• Physical Therapy Assistant in Burlington, NC
• Providers in Burlington, NC by specialty
• Physical Therapy Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.