Active NPI
Michael Cobb Kelly, DPT
- Physical Therapist
- Zachary, LA
National Provider Identifier
1770109449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10619
- Practice address
- 1219 Church St
Zachary, LA 70791-2347 - Phone
- (225) 658-7751
- Fax
- (225) 658-7753
- NPI assigned
- Jun 18, 2020
- Sex
- Male
- 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 | 10619 | LA | Primary |
Addresses
Primary practice location
1219 Church St
Zachary, LA 70791-2347
Mailing address
1219 Church St
Zachary, LA 70791-2347
Phone (225) 658-7751
Other practice location 1
7648 Picardy Ave Ste 300
Baton Rouge, LA 70808-4695
Phone (225) 768-7676
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 |
|---|---|---|---|
| 10619 | LA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592438400000",
"number": "1770109449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1219 CHURCH ST",
"city": "ZACHARY",
"state": "LA",
"postal_code": "707912347",
"telephone_number": "225-658-7751",
"fax_number": "225-658-7753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1219 CHURCH ST",
"city": "ZACHARY",
"state": "LA",
"postal_code": "707912347",
"telephone_number": "225-658-7751",
"fax_number": "225-658-7753"
}
],
"practiceLocations": [
{
"address_1": "7648 Picardy Ave Ste 300",
"address_purpose": "LOCATION",
"city": "Baton Rouge",
"state": "LA",
"postal_code": "708084695",
"country_code": "US",
"telephone_number": "225-768-7676",
"fax_number": "225-768-7373",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KELLY",
"first_name": "MICHAEL",
"middle_name": "COBB",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-18",
"last_updated": "2020-06-18",
"certification_date": "2020-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "10619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Zachary, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.