Keith Martin Liccardi, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT015537 Issued in PA

Practice address

890 Greener PL
Fairview, PA 16415-1567

Phone

(814) 474-5521

NPI assigned

Aug 9, 2010

Sex

Male

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 PA

Enrollment records 1

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 and National Provider Directory roles.

• Clinical Practice of Lecom Institute for Successful Living

  • Multi-Specialty Clinic/Center
  • Erie, PA
  • NPI 1326921487

  PA

  Medicare reassignment NPD

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281312000000",
    "number": "1295040731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 GREENER PL",
            "city": "FAIRVIEW",
            "state": "PA",
            "postal_code": "164151567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 GREENER PL",
            "city": "FAIRVIEW",
            "state": "PA",
            "postal_code": "164151567",
            "telephone_number": "814-474-5521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICCARDI",
        "first_name": "KEITH",
        "middle_name": "MARTIN",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-09",
        "last_updated": "2010-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT015537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Fairview, PA
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2010; 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.