Matthew Kelly, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61031968 Issued in WA

Practice address

9 Hofstra Dr
Smithtown, NY 11787-2018

Phone

(631) 901-5583

NPI assigned

Sep 6, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1760031256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 HOFSTRA DR",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 HOFSTRA DR",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872018",
            "telephone_number": "631-901-5583"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "898 Hampton Rd",
            "address_purpose": "LOCATION",
            "city": "McDonough",
            "state": "GA",
            "postal_code": "302536514",
            "country_code": "US",
            "telephone_number": "678-583-9954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MATTHEW",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-06",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "014321",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61031968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oisin Vincent Keenan
• Amanda Kelly, M.S.
• Carder Kelly, PT
• Dorothy Jane Kelly, LCSW
• John Peter Kelly, PH.D.
• Melinda Kelly, LPN
• Silas W. Kelly, LMSW
• Katelyn Elizabeth Kenah, MA
• Patricia A Kennedy Hingerton, DDS
• Amy Kennedy, PT

• Physical Therapist in Smithtown, NY
• Providers in Smithtown, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.