Active NPI
Kelly Paolisso
- Physical Therapist
- Tucson, AZ
National Provider Identifier
1720130347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10640PT
- Practice address
- 2238 E Ginter Road
Sunnyside Unified School District No 12
Tucson, AZ 85706 - Phone
- (520) 545-2137
- Fax
- (520) 545-2120
- NPI assigned
- Jan 16, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 290846347 | AZ | |
| Physical Therapist | 225100000X | 10640PT | Primary |
Addresses
Primary practice location
2238 E Ginter Road
Sunnyside Unified School District No 12
Tucson, AZ 85706
Mailing address
2238 E Ginter Road
Sunnyside Unified School District No 12
Tucson, AZ 95706
Phone (520) 545-2137
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 875966 | Medicaid | AZ |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 290846347 | AZ | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamite Therapy, LLC | Past | Accepting new patients | |
| Sunnyside Unified School District No. 12 | Past | Accepting new patients | |
| Stepping Up Pediatric Physical Therapy | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Home Health Agency
- Scottsdale, AZ
- NPI 1730388828
-
- Physical Therapist
- Tucson, AZ
- NPI 1558426825
-
- Local Education Agency (LEA)
- Tucson, AZ
- NPI 1740378397
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446076800000",
"number": "1720130347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2238 E GINTER ROAD",
"address_2": "SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12",
"city": "TUCSON",
"state": "AZ",
"postal_code": "95706",
"telephone_number": "520-545-2137",
"fax_number": "520-545-2120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2238 E GINTER ROAD",
"address_2": "SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85706",
"telephone_number": "520-545-2137",
"fax_number": "520-545-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAOLISSO",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2015-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "AZ",
"license": "290846347",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": "10640PT",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "875966",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.