Active NPI
Paul Gerard Kelly, MPT
- Physical Therapist
- Gresham, OR
National Provider Identifier
1972790707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2945
- Practice address
- 405 NE 5TH St
Gresham, OR 97030-7345 - Phone
- (503) 666-5600
- NPI assigned
- Sep 25, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2945 | OR | Primary |
Addresses
Primary practice location
405 NE 5TH St
Gresham, OR 97030-7345
Mailing address
25117 SW Parkway Ave Ste D
Wilsonville, OR 97070-9697
Phone (503) 570-3665
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 |
|---|---|---|---|
| 2945 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190678400000",
"number": "1972790707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25117 SW PARKWAY AVE STE D",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970709697",
"telephone_number": "503-570-3665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 NE 5TH ST",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970307345",
"telephone_number": "503-666-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "PAUL",
"middle_name": "GERARD",
"name_prefix": "Mr.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-25",
"last_updated": "2007-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "2945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.