KELLY MACK (NPI# 1215184056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215184056 |
| Entity Type | Individual |
| Full Name | KELLY MACK |
| Credential | PT |
| Practice Address |
107 Holly Creek Dr Irmo SC 29063-8918 |
| Practice Telephone | 8037491625 |
| Enumeration Date | 2008-08-23 |
| Last Update Date | 2008-08-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251P0200X |
Physical Therapist Specialization: Pediatrics |
2278 | SC | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | THO443 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578896460 | Kelly Mack | Speech-Language Pathologist | 2124 16th St, Boulder, CO 80302-4354 | 2009-09-10 |
| 1780702472 | Kelly Wade Mack | Dentist | 2200 Horseshoe Ln, Longview, TX 75605-5648 | 2007-03-27 |
| 1396813960 | Kelly Leigh Mack | Physician Assistant | 995 N. Prince Frederick Blvd, Suite 204, Prince Frederick, MD 20678 | 2006-12-01 |
| 1003468273 | Kelly Lynne Mack | Nurse Practitioner | 2215 Burdett Ave, Troy, NY 12180-2466 | 2019-07-09 |
| 1972933646 | Kelly Mack | Physical Therapy Assistant | 44480 W Honeycutt Rd, #106, Maricopa, AZ 85138-2903 | 2013-11-17 |
| 1164692455 | Kelly Jene Mack | Counselor | 3737 Portland Rd Ne, Salem, OR 97301-0311 | 2008-03-03 |
| 1457471542 | Kelly S Mack | Nurse Practitioner | 6001 Research Park Blvd, Madison, WI 53719 | 2007-03-30 |
| 1982742888 | Kelly C Mack | Nurse Practitioner | 1800 Williams St, Suite 200, Denver, CO 80218-1234 | 2007-02-02 |
| 1245308899 | Kelly Anne Mack | Dental Hygienist | 55 E Loop Rd, Grove Dental Assoc Suite 201, Wheaton, IL 60187 | 2006-12-01 |
| Street Address |
107 HOLLY CREEK DR |
| City | IRMO |
| State | SC |
| Zip Code | 29063-8918 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720603640 | Daniel Witcher | Counselor | 1180 Columbia Avenue, Suite 203, Irmo, SC 29063 | 2020-06-16 |
| 1710512140 | Arie Anew Services Incorporated | Psychologist | 7803 St. Andrews Road, C5, Irmo, SC 29063 | 2020-03-05 |
| 1366922296 | Jennie C Beym | Speech-Language Pathologist | 7 Tip Top Court, Irmo, SC 29063 | 2018-08-20 |
| 1295214088 | The Well LLC | Massage Therapist | 1720 Dutch Fork Rd., Irmo, SC 29063 | 2018-08-13 |
| 1699268821 | Shannon Marie Kelly | Dentist | 200 N Royal Tower Dr, Irmo, SC 29063 | 2018-06-12 |
| 1497243174 | Anthony Batiste Thompson Jr. | Behavior Technician | 137 Chapelwhite Road, Irmo, SC 29063 | 2018-04-27 |
| 1578076022 | Demario Sawyer Sr | Ambulance | 107 N Royal Tower Dr Ste C, Irmo, SC 29063 | 2017-11-07 |
| 1306365713 | Dreher Shuler | Student in an Organized Health Care Education/Training Program | 205 River Creek Drive, Irmo, SC 29063 | 2017-09-18 |
| 1053833442 | Tania Rodriguez | Social Worker | 30 Ash Court, Irmo, SC 29063 | 2017-07-07 |
| 1598294944 | Ashley Elaine Bradley | Home Health | 120 Stockland Rd, Irmo, SC 29063 | 2017-06-08 |
| Find all providers in zip 29063 | ||||
| Taxonomy Code | 2251P0200X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114559192 | Stephen Bendziewicz | Physical Therapist | 206 Blackstone Dr, Irmo, SC 29063-7838 | 2020-02-07 |
| 1881032548 | Janet Wood Barnes | Physical Therapist | 155 Watersong Ln, Irmo, SC 29063-7610 | 2013-06-04 |
| 1578746764 | Carolina Kids Therapeutic Interventions, LLC | Physical Therapist | 454 Bookman Mill Rd, Irmo, SC 29063-7946 | 2007-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285244756 | Cathy Schreiber | Physical Therapist | 2387 Lantern St, Charleston, SC 29414-4850 | 2020-08-08 |
| 1982221016 | Milestones & Movement Pediatric Physical Therapy, LLC | Physical Therapist | 206 Calm Water Way, Summerville, SC 29486-6902 | 2020-07-06 |
| 1811467939 | Upstate Therapy Works | Physical Therapist | 256 Dellwood Dr, Spartanburg, SC 29301-5023 | 2018-12-01 |
| 1518433028 | Kimberly (kim) Fowler King | Physical Therapist | 334 Monroe Dr, Piedmont, SC 29673-9731 | 2018-10-23 |
| 1346725306 | Walker Physical Therapy & Wellness, LLC | Physical Therapist | 4720 Grey Moss Dr, Clover, SC 29710-8706 | 2018-09-26 |
| 1104313261 | Purposeful Play Pediatric Physical Therapy, LLC | Physical Therapist | 17 Plantation Cir, Summerville, SC 29485-3474 | 2018-04-15 |
| 1649785270 | Jaunitha Magwood | Physical Therapist | 124 Lisa Dr, Summerville, SC 29485-5307 | 2017-12-05 |
| 1629587191 | Playxcience LLC | Physical Therapist | 2023 Taney Way, Indian Land, SC 29707-7488 | 2017-09-27 |
| 1598281255 | Developmental Center for Exceptional Children | Physical Therapist | 1100 West Franklin Street, Anderson, SC 29624 | 2017-08-15 |
| 1871031641 | Spark Therapy Group LLC | Physical Therapist | 9 Drexel Ave, Greenville, SC 29615-1407 | 2017-02-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.