Active NPI
Kevin A Passerby, MPT
- Physical Therapist
- Kingwood, WV
National Provider Identifier
1275546905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 001135
- Practice address
- 150 Memorial Dr
Kingwood, WV 26537-1141 - Phone
- (304) 329-3908
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 001135 | WV | Primary |
Addresses
Primary practice location
150 Memorial Dr
Kingwood, WV 26537-1141
Mailing address
150 Memorial Dr
Kingwood, WV 26537-1141
Phone (304) 329-3908
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2701802 | Medicaid | OH | |
| 156572000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001135 | WV | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain State Physical Therapy LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Mountain State Physical Therapy
- Physical Therapy Clinic/Center
- Fairmont, WV
- NPI 1083668875
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1275546905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 MEMORIAL DR",
"city": "KINGWOOD",
"state": "WV",
"postal_code": "265371141",
"telephone_number": "304-329-3908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 MEMORIAL DR",
"city": "KINGWOOD",
"state": "WV",
"postal_code": "265371141",
"telephone_number": "304-329-3908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PASSERBY",
"first_name": "KEVIN",
"middle_name": "A",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2024-08-14",
"certification_date": "2024-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "001135",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2701802",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "156572000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingwood, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.