Active NPI
Kelsey Lynn Mooney, DPT
- Physical Therapist
- Modesto, CA
National Provider Identifier
1730781303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 299486
- Practice address
- 1917 Coffee Rd
Modesto, CA 95355-2704 - Phone
- (209) 549-4626
- Fax
- (209) 549-4625
- NPI assigned
- Nov 9, 2020
- 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 | 299486 | CA | Primary |
Addresses
Primary practice location
1917 Coffee Rd
Modesto, CA 95355-2704
Mailing address
1502 Seiko Ave
Lodi, CA 95240-7815
Phone (916) 765-8264
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 |
|---|---|---|---|
| 299486 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1730781303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1502 SEIKO AVE",
"city": "LODI",
"state": "CA",
"postal_code": "952407815",
"telephone_number": "916-765-8264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1917 COFFEE RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953552704",
"telephone_number": "209-549-4626",
"fax_number": "209-549-4625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOONEY",
"first_name": "KELSEY",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-09",
"last_updated": "2020-11-09",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "299486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.