Kelly Malloy

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

070021220 Issued in IL

Practice address

811 W Evergreen Ave
Suite 306
Chicago, IL 60642-2682

Phone

(312) 242-1665

NPI assigned

Mar 20, 2015

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Lumiere Children'S Therapy, LLC

  • Developmental - Behavioral Pediatrics Physician
  • Chicago, IL
  • NPI 1497054050
  NPD (past)

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

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426809600000",
    "number": "1881088573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10016 OLCOTT AVE",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 W EVERGREEN AVE",
            "address_2": "SUITE 306",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606422682",
            "telephone_number": "312-242-1665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLOY",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-20",
        "last_updated": "2015-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "IL",
            "license": "070021220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Mallory, LCSW
• Erin Rebecca Mallory, MS D.T.
• Latasha Tene Mallory
• Telice Mallory
• Colleen A Malloy, MD
• Phillip J Malloy, PT
• Riley Shannon Malloy, MS
• Jennifer Mally, LCPC
• Eric Christopher Malm, LCSW
• Stacy Malm, LCPC

• Pediatric Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; 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.