Individual provider Active NPI

Kerry Ann Rafferty, P.T.

  • Physical Therapist
  • Myrtle Beach, SC
National Provider Identifier
1205917994
Registry record updated May 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
0233551 Issued in NY
Practice address
269 Terra Vista Dr
Myrtle Beach, SC 29588-7671
Phone
(631) 512-3267
Fax
(843) 353-0167
NPI assigned
Oct 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2014

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 0233551 NY Primary
Physical Therapist 225100000X SC

Addresses

Primary practice location

269 Terra Vista Dr
Myrtle Beach, SC 29588-7671

Mailing address

269 Terra Vista Dr
Myrtle Beach, SC 29588-7671
Phone (631) 512-3267

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140729002597 SC Practitioner - Physical Therapist in Private Practice 6103887716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Weston Group of South Carolina IncGroup PAC ID 2062651185, 80 clinicians

Practice addresses (Care Compare)

872 Singleton Ridge Rd
Conway, SC 29526-1101
Phone (610) 438-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0233551NYMDPhysical Therapist
6813SCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Weston Group of South Carolina Inc Physical Therapist CurrentSince May 15, 2014 Accepting new patients
KJ Therapy Services, LLC Physical Therapist Current Accepting new patients
Island Rehab & Sports PT PC Physical Therapist Past Accepting new patients

Locations

872 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 347-3050

3736 Robert M Grissom Pkwy
Myrtle Beach, SC 29577
Phone (843) 448-9300

Organizations & group practices 3

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": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1205917994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 TERRA VISTA DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887671",
            "telephone_number": "631-512-3267",
            "fax_number": "843-353-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 TERRA VISTA DR",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295887671",
            "telephone_number": "631-512-3267",
            "fax_number": "843-353-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAFFERTY",
        "first_name": "KERRY",
        "middle_name": "ANN",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0233551",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; 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.