Active NPI
Shannon Dunn Kelley, P.T.
- Physical Therapist
- Crowley, TX
National Provider Identifier
1992056063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1199873
- Practice address
- 1012 S Crowley Rd
# C
Crowley, TX 76036-3664 - Phone
- (817) 297-9670
- NPI assigned
- Sep 28, 2012
- 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 | 1199873 | TX | Primary |
Addresses
Primary practice location
1012 S Crowley Rd
# C
Crowley, TX 76036-3664
Mailing address
4253 Leeds Dr
Crowley, TX 76036
Phone (859) 312-8928
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1199873 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348790400000",
"number": "1992056063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4253 LEEDS DR",
"city": "CROWLEY",
"state": "TX",
"postal_code": "76036",
"telephone_number": "859-312-8928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1012 S CROWLEY RD",
"address_2": "# C",
"city": "CROWLEY",
"state": "TX",
"postal_code": "760363664",
"telephone_number": "817-297-9670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "SHANNON",
"middle_name": "DUNN",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-28",
"last_updated": "2012-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1199873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crowley, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.