Active NPI
Kyle Jacob Birely, PT, DPT
- Physical Therapist
- Peoria, IL
National Provider Identifier
1952006926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.027313
- Practice address
- 2806 N Knoxville Ave
Peoria, IL 61604-2870 - Phone
- (309) 655-6961
- NPI assigned
- Mar 31, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P22028 | NC | |
| Physical Therapist | 225100000X | 070.027313 | IL | Primary |
Addresses
Primary practice location
2806 N Knoxville Ave
Peoria, IL 61604-2870
Mailing address
2806 N Knoxville Ave
Peoria, IL 61604-2870
Phone (309) 655-6961
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.027313 | IL | MD | Physical Therapist |
| P22028 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680220800000",
"number": "1952006926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2806 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616042870",
"telephone_number": "309-655-6961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2806 N KNOXVILLE AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616042870",
"telephone_number": "309-655-6961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BIRELY",
"first_name": "KYLE",
"middle_name": "JACOB",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-31",
"last_updated": "2023-03-31",
"certification_date": "2023-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P22028",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.027313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.