Individual provider Active NPI

Liam James Kavin, DPT

  • Physical Therapist
  • Santa Fe, NM
National Provider Identifier
1093285181
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT5603 Issued in NM
Practice address
15 Dulce Rd
Santa Fe, NM 87508-8284
Phone
(207) 319-5348
NPI assigned
Nov 30, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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 043668 NY
Physical Therapist 225100000X PT5603 NM Primary

Addresses

Primary practice location

15 Dulce Rd
Santa Fe, NM 87508-8284

Mailing address

15 Dulce Rd
Santa Fe, NM 87508-8284
Phone (207) 319-5348

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190221001121 NY Practitioner - Physical Therapist in Private Practice 7517205305 Reassigns benefits to 1 organization
I20191227000217 TX Practitioner - Physical Therapist in Private Practice 7517205305 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT5603NMMDPhysical Therapist
043668NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Oct 31, 2019 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic Physical Therapist CurrentSince Mar 1, 2025 Accepting new patients
Sports Physical Therapy Occupational Therapy and Rehabilitation Servic CurrentSince Mar 1, 2025 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Oct 31, 2019 Accepting new patients

Locations

801 Merrick Ave
East Meadow, NY 11554
Phone (516) 393-8900

9525 Queens Blvd
Ste 3D
Rego Park, NY 11374
Phone (718) 925-6212

972 Brush Hollow Rd
Fl 4
Westbury, NY 11590
Phone (516) 321-7526

Organizations & group practices 4

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": "1543536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1093285181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 DULCE RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875088284",
            "telephone_number": "207-319-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 DULCE RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875088284",
            "telephone_number": "207-319-5348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVIN",
        "first_name": "LIAM",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-30",
        "last_updated": "2023-07-12",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "043668",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "PT5603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Fe, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; 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.