Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenneth Jason Kelly, PT, DPT

Individual provider Physical Therapist · NPI 1821301961

Kenneth Jason Kelly, PT, DPT is a Physical Therapist in Private Practice in Colonial Heights, Virginia. Qualified in 2010, 16 years ago. Practices with Tidewater Physical Therapy LLC, a 222-clinician group and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
16
Licensed in
VA
In the registry since
2010
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

300B Temple Lake Dr Ste 1
Colonial Heights, VA 23834-2973
Phone: (804) 524-9036
Fax: (804) 524-9039
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 2305206555 (VA)

Record details

NPI number1821301961
Entity typeIndividual (Type 1)
GenderMale
Credentials PT , DPT
Sole proprietorNo
NPI enumeratedJuly 19, 2010
Last updated in NPPESMay 27, 2020
Certification dateMay 27, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Tidewater Physical Therapy Llc — 222 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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