Individual provider Active NPI

Kami Guertin, MPT

  • Physical Therapist
  • Houston, TX
National Provider Identifier
1083721963
Registry record updated Nov 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
TX1166408 Issued in TX
Practice address
11450 Space Center Blvd
Suite 201
Houston, TX 77059-3641
Phone
(281) 998-0901
Fax
(281) 998-0903
NPI assigned
Aug 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X TX1166408 TX Primary

Addresses

Primary practice location

11450 Space Center Blvd
Suite 201
Houston, TX 77059-3641

Mailing address

1805 Wynchase Dr
Deer Park, TX 77536-7603
Phone (281) 478-0808

Other identifiers 1

IdentifierTypeStateIssuer
1166408OtherTXLICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091019000029 TX Practitioner - Physical Therapist in Private Practice 7517004989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agility Physical Therapy and Sports Rehabilitation,LLCGroup PAC ID 3476870007, 5 clinicians

Practice addresses (Care Compare)

11450 Space Ctr Blvd
Suite 201
Houston, TX 77059-3642
Phone (281) 998-0901

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TX1166408TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Agility Physical Therapy and Sports Rehabilitation, LLC Physical Therapist CurrentSince Jan 5, 2015 Accepting new patients

Locations

306 W Edgewood Dr
Ste E
Friendswood, TX 77546
Phone (281) 998-0901

11450 Space Center Blvd
Ste 201
Houston, TX 77059
Phone (281) 988-0901

2047 W Main St
Ste A10
League City, TX 77573
Phone (281) 207-7575

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479772800000",
    "number": "1083721963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 WYNCHASE DR",
            "city": "DEER PARK",
            "state": "TX",
            "postal_code": "775367603",
            "telephone_number": "281-478-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11450 SPACE CENTER BLVD",
            "address_2": "SUITE 201",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770593641",
            "telephone_number": "281-998-0901",
            "fax_number": "281-998-0903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUERTIN",
        "first_name": "KAMI",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2016-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "TX1166408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "1166408",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; 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.