Active NPI
Lisa Kelly, PT
- Physical Therapist
- Boulder, CO
National Provider Identifier
1679710305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5125
- Practice address
- 3434 47TH St
Suite 107
Boulder, CO 80301-1880 - Phone
- (303) 440-7078
- NPI assigned
- Jan 16, 2009
- 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 | 5125 | CO | Primary |
Addresses
Primary practice location
3434 47TH St
Suite 107
Boulder, CO 80301-1880
Mailing address
3434 47TH St
Suite 107
Boulder, CO 80301-1880
Phone (303) 440-7078
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 |
|---|---|---|---|
| 5125 | CO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344470400000",
"number": "1679710305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3434 47TH ST",
"address_2": "SUITE 107",
"city": "BOULDER",
"state": "CO",
"postal_code": "803011880",
"telephone_number": "303-440-7078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3434 47TH ST",
"address_2": "SUITE 107",
"city": "BOULDER",
"state": "CO",
"postal_code": "803011880",
"telephone_number": "303-440-7078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "LISA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-16",
"last_updated": "2012-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "5125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.