MARY KELLY (PT) – Pediatric Physical Therapist, NPI 1073590212
Pediatric Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,030 PHYSICAL THERAPIST IN PRIVATE PRACTICE in IL
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Provider Addresses for MARY KELLY (PT)
2011 DEAN ST STE B
ST CHARLES, IL 601744802
Phone: (630) 584-1411
Fax: (630) 513-2630
Type: Mailing
Kaneville Road, Geneva, Kane County, Illinois, 60134, United States
GENEVA, IL 60134
Phone: (630) 584-1411
Fax: (630) 513-2630
Type: Location
3381 W MAIN ST STE 1
ST CHARLES, IL 601751008
Phone: (630) 549-0511
Fax: (630) 549-0512
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-11-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20051110000483 | I | Physical Therapist In Private Practice | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 134 | 30 | $0 |
| 97140 | Therapy procedure using manual technique, each 15 minutes | 121 | 30 | $0 |
| 97530 | Therapy procedure using functional activities | 85 | 22 | $0 |
| 97162 | Evaluation for physical therapy, typically 30 minutes | 20 | 19 | $0 |
Insurance plans in this area (ZIP 60174)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICAL THERAPY | IL | 97110 | Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 421 | 31 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | NY | |
| Physical Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | SC | |
| Physical Therapist In Private Practice | IL | |
| Physical Therapist In Private Practice | IL |
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