Keoni Rei Stallworth, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT306848 Issued in CA

Practice address

1640 Marengo St Hba 102
Los Angeles, CA 90089-3603

Phone

(323) 865-1200

NPI assigned

Jun 11, 2024

Last updated

Mar 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Southern California Keck School of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Usc Care Medical Group, Inc

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1902846306
  Medicare reassignment Care Compare group NPD
• Usc Care Medical Group, Inc

  dba Fair Oaks Clinic

  • Durable Medical Equipment & Medical Supplies
  • Pasadena, CA
  • NPI 1427937390
  NPD

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

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1154163186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "626-457-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 MARENGO ST HBA 102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900893603",
            "telephone_number": "323-865-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLWORTH",
        "first_name": "KEONI",
        "middle_name": "REI",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-11",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT306848",
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "CA",
            "license": "PENDING",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cleante M Stain, LCSW
• Stairway to Recovery Drug and Alcohol Rehabilitaiton Facility
• Chinwe Ojukwu Stakely, CASE MANAGER
• Erin M Staley
• Scott Douglas Stallard
• Olivfaun Stallworth
• James E Stalnaker-Beck
• Jocelyn Carol Stamat, M.D.
• Erin Stamatelaky, MS, AMFT
• Kaela Sara Shepard Stambor

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; 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.