Active NPI
Kelly Colleen Farrell Moffitt, PT, DPT
- Physical Therapist
- Tucson, AZ
National Provider Identifier
1760834154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- LPT-012573
- Practice address
- 2600 N. Wyatt Dr.
Tucson, AZ 85712-6106 - Phone
- (520) 324-3027
- Fax
- (520) 324-3128
- NPI assigned
- Jul 8, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0014057 | CO | |
| Physical Therapist | 225100000X | LPT-012573 | AZ | Primary |
Addresses
Primary practice location
2600 N. Wyatt Dr.
Tucson, AZ 85712-6106
Mailing address
2600 N. Wyatt Dr.
Tucson, AZ 85712-6106
Phone (520) 324-3027
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 552763 | Medicaid | AZ |
Other names 1
- Kelly Colleen Farrell
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0014057 | CO | MD | Physical Therapy Assistant |
Organizations & group practices 1
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.
-
dba Children's Clinics
- Multi-Specialty Clinic/Center
- Tucson, AZ
- NPI 1063454346
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644624000000",
"number": "1760834154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 N. WYATT DR.",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857126106",
"telephone_number": "520-324-3027",
"fax_number": "520-324-3128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 N. WYATT DR.",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857126106",
"telephone_number": "520-324-3027",
"fax_number": "520-324-3128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARRELL MOFFITT",
"first_name": "KELLY",
"middle_name": "COLLEEN",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-08",
"last_updated": "2022-02-12",
"certification_date": "2022-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "0014057",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "LPT-012573",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "552763",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "FARRELL",
"middle_name": "COLLEEN",
"code": "5",
"type": "Other Name"
}
]
}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 Feb 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.