Provider Demographics
NPI:1770729667
Name:MAPES, KELLY L (LPT)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:L
Last Name:MAPES
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
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Mailing Address - Street 1:307 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4010
Mailing Address - Country:US
Mailing Address - Phone:423-967-5825
Mailing Address - Fax:956-262-7756
Practice Address - Street 1:205 W EDINBURG AVE
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-1769
Practice Address - Country:US
Practice Address - Phone:956-262-1037
Practice Address - Fax:956-262-7756
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306286225100000X
TX1131290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183477202Medicaid
TX454880Medicare Oscar/Certification