Kelsea Teresa Brajkovich, PT, DPT

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT293540 Issued in CA

Practice address

1625 Aviation Blvd
Redondo Beach, CA 90278-2807

Phone

(310) 374-1614

Fax

(310) 374-1843

NPI assigned

Oct 17, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Evolution Physical Therapy IncGroup PAC ID 0244336964, 72 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evolution Physical Therapy, Inc

  • Physical Therapist
  • Culver City, CA
  • NPI 1174601116
  Medicare reassignment Care Compare group NPD
• Next Phase Medical PC

  • General Practice Physician
  • Culver City, CA
  • NPI 1821961863

  Physical Therapy

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1023529070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 AVIATION BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902782807",
            "telephone_number": "310-374-1614",
            "fax_number": "310-374-1843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 AVIATION BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902782807",
            "telephone_number": "310-374-1614",
            "fax_number": "310-374-1843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAJKOVICH",
        "first_name": "KELSEA",
        "middle_name": "TERESA",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT293540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Bowman, MS, CCC-SLP
• Jacqueline Natasha Boyd, LM, CPM
• Latreva Janice Braden
• Mary Braheny, MA, M.F.T.
• Brain Initiative
• Christina A Brandlin
• Nora Branning, P.A.
• Brent L Bates Chiropractic Inc
• Bright Day Therapy Center Inc
• Madison Brightwell, MFT

• Physical Therapy Clinic/Center in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.