MEDICARE: KAREN ELIZABETH KELLY PT, DPT

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
1	225100000X	Physical Therapist	004346	IA
2	225100000X	Physical Therapist	PTH5857	AL
3	225100000X	Physical Therapist	070-017110	IL
4	225100000X	Physical Therapist	1194160	TX
5	2251X0800X	Orthopedic Physical Therapist	39545	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1194160	OTHER	TX	TEXAS PHYSICAL THERAPY LICENSE
2	070-017110	OTHER	IL	ILLINOIS PT LICENSE NUMBER
3	004346	OTHER	IA	IOWA PHYSICAL THERAPY LICENSE
4	39545	OTHER	CA	CA LICENSE
5	PTH5857	OTHER	AL	ALABAMA PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1871730556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ELIZABETH KELLY PT, DPT

Provider Business Mailing Address
First Line	:	44651 VILLAGE CT STE 120
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3823
Country	:	US
Telephone Number	:	760-501-6655
Fax Number	:	760-262-3773

Provider Business Practice Location Address
First Line	:	44651 VILLAGE CT STE 120
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3823
Country	:	US
Telephone Number	:	760-501-6655
Fax Number	:	760-262-3773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	04/21/2026

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