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NPI Code Detail

MEDICARE: KELLY HUME PT

MEDICARE: KELLY HUME PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistLPT31585AZ
22251P0200XPediatric Physical Therapist26604CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LPT31585OTHERAZPT
2PT26604OTHERCALICENSE #

General Provider Information

NPI Number : 1154458313
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY HUME PT
Provider Business Mailing Address
First Line : 26 PRONGHORN LN
Second Line :
City : ELGIN
State : AZ
Zip : 85611-7512
Country : US
Telephone Number : 760-275-5597
Fax Number :
Provider Business Practice Location Address
First Line : 3305 E FRY BLVD
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-2990
Country : US
Telephone Number : 520-515-2754
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 09/24/2025

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