Charles Kelly

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2139360 Issued in TX

Practice address

401 Oakwood Blvd
Round Rock, TX 78681

Phone

(512) 388-7494

NPI assigned

Aug 16, 2018

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534550400000",
    "number": "1922588292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 OAKWOOD BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 OAKWOOD BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "78681",
            "telephone_number": "512-388-7494"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "609 Cactus Flower Dr",
            "address_purpose": "LOCATION",
            "city": "Cedar Park",
            "state": "TX",
            "postal_code": "786134241",
            "country_code": "US",
            "telephone_number": "512-318-0299",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-16",
        "last_updated": "2018-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2139360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Earl Kellar, LPC
• Kellerman Chiropractic Center LLC
• Nicolas L Kellerman, D.C.
• Marwa Kelley, MS, LPC
• Herbert Kellins, D.C.
• Daniel Joseph Kelly, M.D.
• Italia Kelly
• Patrick Guenette Kelly, DPT
• Tamara Kelm
• Molly Kendrick

• Physical Therapy Assistant in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2018; 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.