Kelly Ann Donathan, DPT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11279 Issued in CO

Practice address

7815 3Rd St N Ste 203
Oakdale, MN 55128-5443

Phone

(952) 835-4512

NPI assigned

Jun 28, 2011

Last updated

Aug 5, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kelly Ann Dougherty Former name

Medicare fee-for-service enrollment

Enrolled in IL, UT2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Crystal Lake Physical Therapy IncGroup PAC ID 1254636491, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crystal Lake Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Crystal Lake, IL
  • NPI 1326404682

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Mountain Land Rehabilitation LLC

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1265549372
  Medicare reassignment NPD
• Registered Physical Therapists LLC

  • Physical Therapist
  • Sandy, UT
  • NPI 1477582633
  Medicare reassignment NPD
• Titan Medical Associates LTD.

  • Clinic/Center
  • West Dundee, IL
  • NPI 1407571664
  NPD
• Viverant, LLC

  • Physical Therapist
  • Oakdale, MN
  • NPI 1760418164
  NPD (past)
• Huntley Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Huntley, IL
  • NPI 1558895797

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438732800000",
    "number": "1770879793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7815 3RD ST N STE 203",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551285443",
            "telephone_number": "952-835-4512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7815 3RD ST N STE 203",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551285443",
            "telephone_number": "952-835-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONATHAN",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "credential": "DPT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2015-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "11279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BOARD OF PT",
            "identifier": "9844",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DOUGHERTY",
            "middle_name": "ANN",
            "credential": "DPT, ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather Deveny-Leggitt, LICSW
• Gena M Dickens, LICSW
• Robert C. Dinga, O.D.
• Lucas Dinh
• Ayan Diriye
• Angie Donnay
• Tricia Anne Downing, LICSW
• Brianna Drude
• Erin Drummer, MA, LMFT
• Ahmed Nor Duale

• Physical Therapist in Oakdale, MN
• Providers in Oakdale, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.