Andrew Edward Kelly, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

15707 Issued in CA

Practice address

165 N Redwood Dr
San Rafael, CA 94903-1969

Phone

(415) 499-0278

Fax

(415) 499-0297

NPI assigned

Jul 29, 2005

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1871593004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 N REDWOOD DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031970",
            "telephone_number": "415-499-0278",
            "fax_number": "415-499-0297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 N REDWOOD DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949031969",
            "telephone_number": "415-499-0278",
            "fax_number": "415-499-0297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ANDREW",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "15707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD IND PROV NO",
            "identifier": "OPT15707",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "ZZZ64636Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Keeney-Roe, PT, MS
• Kimberlie Keller, DO
• Robert W. Keller
• Valerie Irene Keller, MFTI
• Christopher Lyle Ivan Kellogg, MA
• Eric Kelly, MFT
• Jeremy Ray Kelsay
• Carmalita Marshall Kemayo
• Michelle Rae Kemp, CERTIFIED PEER
• Maryann Kemper, MFT

• Physical Therapist in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; 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.