Active NPI
Kelly Walsh, PT, DPT
- Physical Therapist
- Raleigh, NC
National Provider Identifier
1790227858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P16754
- Practice address
- 4201 Lake Boone TRL
Suite 4
Raleigh, NC 27607-7512 - Phone
- (919) 781-4434
- NPI assigned
- Nov 7, 2016
- Sex
- Female
- 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 | P16754 | NC | Primary |
Addresses
Primary practice location
4201 Lake Boone TRL
Suite 4
Raleigh, NC 27607-7512
Mailing address
4201 Lake Boone TRL
Suite 4
Raleigh, NC 27607-7512
Phone (919) 781-4434
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 |
|---|---|---|---|
| P16754 | NC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Associates | Physical Therapist | Past | Accepting new patients |
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.
-
- Physical Therapist
- Raleigh, NC
- NPI 1447310958
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478476800000",
"number": "1790227858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 LAKE BOONE TRL",
"address_2": "SUITE 4",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077512",
"telephone_number": "919-781-4434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 LAKE BOONE TRL",
"address_2": "SUITE 4",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077512",
"telephone_number": "919-781-4434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALSH",
"first_name": "KELLY",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-07",
"last_updated": "2016-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P16754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.