Samuel A Kibrom, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P12143 Issued in NC

Practice address

11200 Governor Manly Way
Suite 309
Raleigh, NC 27614-8599

Phone

(919) 562-9410

NPI assigned

Nov 12, 2008

Last updated

May 14, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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 NC

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Care First Physical Therapy & Rehab, LLC

  • Occupational Therapist
  • Cary, NC
  • NPI 1932366044

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336953600000",
    "number": "1063666337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 GOVERNOR MANLY WAY",
            "address_2": "SUITE 309",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148599",
            "telephone_number": "919-562-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 GOVERNOR MANLY WAY",
            "address_2": "SUITE 309",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148599",
            "telephone_number": "919-562-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIBROM",
        "first_name": "SAMUEL",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-12",
        "last_updated": "2012-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P12143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Brooke Khoury
• Sara Khov
• Kian Surgery Center
• Alyssa Marie Kiani, AGNP
• Kiarash Bassiri, OD, PA (Fusion Eye Care)
• Carissa Marie Kicinski, PA-C
• Stephen Downer Kicklighter, M.D.
• Henry Matthews Kidd Jr., DDS
• Kids First Pediatrics of Raleigh, PLLC (Kids First Pediatrics of Clayton)
• Kids R US Therapy, Inc.

• Physical Therapist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.