Kinesio Physical Therapy and Sports Rehabilitation, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

17817 Issued in MD

Legal business name

KINESIO PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC

Practice address

821 W Benfield Rd
Suite 7
Severna Park, MD 21146-2220

Phone

(443) 994-2640

NPI assigned

Jan 21, 2014

Organization subpart

No

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

Authorized official

Name

Faith K Hagerty, P.T.NPI 1578634077

Title

Managing Member

Phone

(410) 987-5746

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Faith Hagerty, M.P.T.

  • Physical Therapist
  • Annapolis, MD
  • NPI 1578634077
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1390262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390262400000",
    "number": "1073936407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 RED BIRCH RD",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211081414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 W BENFIELD RD",
            "address_2": "SUITE 7",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211462220",
            "telephone_number": "443-994-2640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINESIO PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-21",
        "last_updated": "2014-01-21",
        "status": "A",
        "authorized_official_last_name": "HAGERTY",
        "authorized_official_first_name": "FAITH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "410-987-5746",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "17817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NPI INDIVIDUAL",
            "identifier": "1578634077",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDENTIFICATION NUMBER",
            "identifier": "320171",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin L Laser MD
• Amir Hossain Khodabandelou
• Paxton Kieley
• Michelle Kim
• Lennee' Maria Kimbell
• Paul J Kinsey, DDS
• Lynn Kitzmiller, P.T.
• Lee A Kleiman, M.D.
• Olivia Catherine Klein
• Kimberly Ann Knight, RN, IBCLC, RLC

• Physical Therapist in Severna Park, MD
• Providers in Severna Park, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; 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.