Active NPI
Kerrisa Lynn Smith, PT
- Physical Therapist
- Brookline, MA
National Provider Identifier
1275785222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17100
- Practice address
- 258 Harvard St
# 476
Brookline, MA 02446-2904 - Phone
- (518) 461-6925
- NPI assigned
- Oct 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 17100 | MA | Primary |
| Physical Therapist | 225100000X | PT60041775 | WA | |
| Physical Therapist | 225100000X | 62 026805 | NY |
Addresses
Primary practice location
258 Harvard St
# 476
Brookline, MA 02446-2904
Mailing address
258 Harvard St
# 476
Brookline, MA 02446-2904
Phone (518) 461-6925
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17100 | MA | MD | Physical Therapist |
| 62 026805 | NY | MD | Physical Therapist |
| PT60041775 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224547200000",
"number": "1275785222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "258 HARVARD ST",
"address_2": "# 476",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462904",
"telephone_number": "518-461-6925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "258 HARVARD ST",
"address_2": "# 476",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024462904",
"telephone_number": "518-461-6925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "KERRISA",
"middle_name": "LYNN",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-21",
"last_updated": "2008-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "17100",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT60041775",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "62 026805",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.