Theresa Ketterhagen, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT12185 Issued in CA

Practice address

11677 San Vicente Blvd
Ste 207
Los Angeles, CA 90049-5128

Phone

(310) 743-6649

NPI assigned

Jan 22, 2010

Last updated

Apr 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Skyfall Physical Therapy

  • Physical Therapist
  • Los Angeles, CA
  • NPI 1982126728
  Medicare reassignment NPD Authorized official
• Kim M Finklestein Physical Therapy Inc

  dba Postureworks Physical Therapy

  • Physical Therapist
  • Santa Monica, CA
  • NPI 1174697130
  NPD (past)
• Lori Rubenstein Physical Therapy, Inc

  dba Mosaic Physical Therapy

  • Specialist
  • Los Angeles, CA
  • NPI 1447321666
  NPD (past)
• Total Rehab Institute Inc

  dba The Balance Disorders Institute

  • Physical Therapist
  • Beverly Hills, CA
  • NPI 1003863762
  NPD (past)

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

{
    "created_epoch": "1264118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1235460767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491471",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900499471",
            "telephone_number": "310-743-6649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11677 SAN VICENTE BLVD",
            "address_2": "STE 207",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495128",
            "telephone_number": "310-743-6649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETTERHAGEN",
        "first_name": "THERESA",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-22",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT12185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ketamine Clinics LLC (Ketamine Clinics of Los Angeles)
• Georgia Ketcham
• Nayiri Zetlian Ketchedjian, NP-C
• Aline S. Ketefian, MD
• Danielle Darby Ketter, MT
• Christopher Paul Keup, M.D.
• Apel Keuroghlian, MD
• Simon M. Keushkerian, M.D.
• Kevin B. Seto, D.D.S, M.S., P.C.
• Kevin Barrett DDS Inc

• 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 Apr 16, 2021; 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.