Individual provider Active NPI

Konnar Kechely, PT, DPT

  • Physical Therapist
  • Georgetown, TX
National Provider Identifier
1710782032
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1404632 Issued in TX
Practice address
1013 W University Ave Ste 335
Georgetown, TX 78628-5343
Phone
(512) 876-2111
NPI assigned
Feb 19, 2025
Last updated
Feb 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1404632 TX Primary

Addresses

Primary practice location

1013 W University Ave Ste 335
Georgetown, TX 78628-5343

Mailing address

2001 Butterfield Rd Ste 1600
Downers Grove, IL 60515-1211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250325001328 TX Practitioner - Physical Therapist in Private Practice 8426571068 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1013 W University Ave
Suite 335
Georgetown, TX 78628-5343
Phone (512) 876-2111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1404632TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Feb 17, 2025 Accepting new patients
Ideal Physical Therapy of Texas LLC CurrentSince Feb 17, 2025 Accepting new patients

Locations

2001 Butterfield Rd
Ste 1600
Downers Grove, IL 60515

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

1013 W University Ave
Ste 335
Georgetown, TX 78628
Phone (512) 876-2111

5400 Brodie Ln
Ste 295
Sunset Valley, TX 78745
Phone (512) 676-3949

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.

NPI Registry JSON

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

{
    "created_epoch": "1739923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1710782032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BUTTERFIELD RD STE 1600",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 W UNIVERSITY AVE STE 335",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786285343",
            "telephone_number": "512-876-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KECHELY",
        "first_name": "KONNAR",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-19",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1404632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.