Ian Christopher Kelley

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501302420 Issued in MI

Practice address

13329 Portage Rd
Vicksburg, MI 49097-9496

Phone

(269) 649-2400

Fax

(269) 649-0548

NPI assigned

Jan 3, 2023

Last updated

Jan 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Ivyrehab Michigan, LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fenton, MI
  • NPI 1104337120

  Physical Therapist

  NPD
• Ivyrehab Northern PT, LLC

  • Physical Therapy Clinic/Center
  • Sparta, MI
  • NPI 1972592525
  NPD (past)
• Physical Therapy One, P.C.

  • Physical Therapist
  • Portage, MI
  • NPI 1962499855
  NPD (past)

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1821701194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13329 PORTAGE RD",
            "city": "VICKSBURG",
            "state": "MI",
            "postal_code": "490979496",
            "telephone_number": "269-649-2400",
            "fax_number": "269-649-0548"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7119 W Q Ave",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490095951",
            "country_code": "US",
            "telephone_number": "269-447-1560",
            "fax_number": "269-447-1561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3282 Stadium Dr",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490081527",
            "country_code": "US",
            "telephone_number": "269-375-1400",
            "fax_number": "269-375-1401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1423 W Centre Ave",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "MI",
            "postal_code": "490245323",
            "country_code": "US",
            "telephone_number": "269-323-4300",
            "fax_number": "269-323-4449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "IAN",
        "middle_name": "CHRISTOPHER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501302420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hope's Halo Therapy Collective, PLLC
• Thomas A Howard, D.O.
• Jemellee Perpetua Jacala-Tadian, M.D.
• Kate Lynn-Kuschel Johnson, MA, LPC
• Journey Toward Hope Counseling
• Karl Robert Kerchief, MD
• Kevin Palmer Chiropractic
• Jo Lynne Kirchhoff, RPH
• Debra Klinger
• Lan Medical

• Physical Therapist in Vicksburg, MI
• Providers in Vicksburg, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.