Active NPI
Shelly Kennedy
- Physical Therapist
- Albuquerque, NM
National Provider Identifier
1760970305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTA1508
- Practice address
- 2924 Santa Clara Ave SE
Albuquerque, NM 87106-2947 - Phone
- (505) 515-7748
- NPI assigned
- Apr 30, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTA1508 | NM | Primary |
Addresses
Primary practice location
2924 Santa Clara Ave SE
Albuquerque, NM 87106-2947
Mailing address
2924 Santa Clara Ave SE
Albuquerque, NM 87106-2947
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 |
|---|---|---|---|
| PTA1508 | NM | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525046400000",
"number": "1760970305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2924 SANTA CLARA AVE SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2924 SANTA CLARA AVE SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062947",
"telephone_number": "505-515-7748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "SHELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-30",
"last_updated": "2018-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "PTA1508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.