Mary Ibrahim, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

CP054196T Issued in VA

Practice address

4831 S Laburnum Ave
Richmond, VA 23231-2713

Phone

(804) 222-0745

Fax

(804) 222-0748

NPI assigned

Jun 4, 2025

Last updated

Aug 25, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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 NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sportscare of America, PCGroup PAC ID 9032213756, 132 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.

• Sportscare of America, PC

  • Physical Therapist
  • East Hanover, NJ
  • NPI 1851484380
  Medicare reassignment Care Compare group NPD
• United Sports Care & Physical Therapy

  • Occupational Therapist
  • Cedar Knolls, NJ
  • NPI 1972881233

  Physical Therapist

  Medicare reassignment NPD
• Sportscare Institute, Inc.

  • Physical Therapist
  • Toms River, NJ
  • NPI 1275501074
  NPD (past)

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

{
    "created_epoch": "1748995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1194619353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-6200",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4831 S LABURNUM AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232312713",
            "telephone_number": "804-222-0745",
            "fax_number": "804-222-0748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "151 Centre St Ste A",
            "address_purpose": "LOCATION",
            "city": "Bayonne",
            "state": "NJ",
            "postal_code": "070027224",
            "country_code": "US",
            "telephone_number": "201-858-0550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IBRAHIM",
        "first_name": "MARY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-04",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "CP054196T",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02334900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Ianniello, PA
• Iasis Counseling and Consulting Services
• Ezechukwu Prince Ibekwe, RN
• Jada Monique Ibekwe
• Iman Mohamoud Ibrahim, MD
• Minatallah Mutasim Ibrahim, DDS
• Ic Hope
• Marissa Icardi, DPM
• Icare Therapy VA LLC
• Thomas Carroll Iden, MD

• Physical Therapist in Richmond, VA
• Providers in Richmond, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; 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.