Kelli Richardson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2010021791 Issued in MO

Practice address

2840 Clark Ave
Saint Louis, MO 63103-2506

Phone

(314) 970-2466

Fax

(314) 949-2523

NPI assigned

Jul 26, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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 and National Provider Directory roles.

• Mitas LLC

  dba Axis Spine and Orthopedics

  • Orthopaedic Surgery Physician
  • Shiloh, IL
  • NPI 1659967917

  Physical Therapist

  Medicare reassignment NPD
• Metro East Dermatology & Skin Cancer Center LLC

  • Dermatology Physician
  • Shiloh, IL
  • NPI 1518494996
  NPD (past)

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

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1871806398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2840 CLARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032506",
            "telephone_number": "314-970-2466",
            "fax_number": "314-949-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2840 CLARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631032506",
            "telephone_number": "314-970-2466",
            "fax_number": "314-949-2523"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1191 Fortune Blvd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Shiloh",
            "state": "IL",
            "postal_code": "622697474",
            "country_code": "US",
            "telephone_number": "618-607-0061",
            "fax_number": "618-615-4290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KELLI",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-26",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.028221",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2010021791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kari Richardson
• Katherine Richardson, RD
• Katonna Richardson, RN, NNP
• Kayla Richardson, M.S., CCC-SLP, IBCLC
• Kayla Christine Richardson
• Kristen M Richardson, FNP
• Miesha Richardson
• Myndee Richardson, NP-C
• Olivia Richardson, M.A., CF-SLP
• Randall Richardson

• Physical Therapist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.