Shawn Kelly, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2972 Issued in SC

Practice address

1204 South Blvd
North Charleston, SC 29405-5228

Phone

(843) 200-7806

Fax

(843) 200-7806

NPI assigned

Dec 14, 2014

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1418515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418515200000",
    "number": "1710385356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 SOUTH BLVD",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294055228",
            "telephone_number": "843-200-7806",
            "fax_number": "843-200-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 SOUTH BLVD",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294055228",
            "telephone_number": "843-200-7806",
            "fax_number": "843-200-7806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHAWN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-14",
        "last_updated": "2014-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "2972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Wilkes Keating, MS, LCGC
• Robert Jason Keene, D.P.T.
• Kelly Ann Kelleher, COTA
• Ayoe Alexa Kelly, DPT, PT
• Heather Kelly
• Stephanie Albers Kelly, R.N.
• Marissa Kemp, DNP, CPNP-PC
• Kelli Kennedy, LPC
• Marion Mance Kenney, O.D.
• Bridget E Kenny, C.N.M

• Physical Therapy Assistant in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2014; 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.