Kelly Matisi, DPT
Individual provider Active NPI Physical Therapist · Richmond, RI
NPI 1760177786 · NPPES record last updated Apr 6, 2023
Key facts
- NPI
- 1760177786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT03627 (RI)
- Practice address
- 12 Stilson Rd
Richmond, RI 02898-1026 - Phone
- (401) 726-7100
- Fax
- (401) 539-4601
- NPI assigned
- Apr 6, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in RI, CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230421000220 | RI | Practitioner - Physical Therapist in Private Practice | 8527423896 | Reassigns benefits to 2 organizations |
| I20240415001128 | CT | Practitioner - Physical Therapist in Private Practice | 8527423896 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT03627 | RI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Silver Fern Practice, LLC | Physical Therapist | Current |
Accepting new patients |
| Metro Physical Occupational and Speech Therapy of CT LLC | Physical Therapist | Current |
Accepting new patients |
| Silver Fern Practice, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
969 Poquonnock Rd
Groton, CT 06340
Phone (860) 967-7342
14 Clara Dr
Ste 3
Mystic, CT 06355
Phone (860) 245-0851
800 E Gate Blvd
Garden City, NY 11530
4 Richmond Sq
Ste 200
Providence, RI 02906
41 Sanderson Rd
Ste 101
Smithfield, RI 02917
Phone (401) 349-4540
1 James P Murphy Ind Hwy
Ste 103
West Warwick, RI 02893
Phone (401) 615-0648
85 Beach St
#D
Westerly, RI 02891
Phone (401) 348-8112
85 Beach St
Westerly, RI 02891
Phone (401) 348-8112
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT03627 | RI | Yes |
Addresses
Primary practice location
12 Stilson Rd
Richmond, RI 02898-1026
Mailing address
4 Richmond SQ Ste 200
Providence, RI 02906-5117
Phone (401) 433-4172
Other providers in Richmond, RI
- Michael David Jamieson
- Thomas Joyce
- Christopher Denis Levesque
- Kaitlin Liese
- Kelly Margaret Marsella
- Maxi Drug South LP
- Cara E McLaughlin
- Ralph Le Misto III
- Lisa Moniz
- Perspectives Corporation
All providers in Richmond, RI · Physical Therapist in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.