Kristine M Villarta, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305213251 Issued in VA

Practice address

10 Saint Patricks Dr
Suite 401
Waldorf, MD 20603-4527

Phone

(301) 870-6717

Fax

(301) 870-7366

NPI assigned

Sep 27, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Miss Kristine Bomediano Former name

Medicare fee-for-service enrollment

Enrolled in DC, VA, MD3 enrollments

Enrollment records 3

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

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 and National Provider Directory roles.

• Legacy Healthcare Services Inc

  • Physical Therapist
  • Baltimore, MD
  • NPI 1215698287
  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Roanoke, VA
  • NPI 1740820828
  Medicare reassignment NPD
• Legacy Healthcare Services, Inc

  • Physical Therapist
  • Washington, DC
  • NPI 1255750030
  Medicare reassignment NPD
• Legacy Healthcare Services, Inc.

  • Physical Therapist
  • Silver Spring, MD
  • NPI 1376151811
  NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489
  NPD

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571961600000",
    "number": "1427044189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7503 SURRATTS RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353358",
            "telephone_number": "301-870-7001",
            "fax_number": "302-870-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SAINT PATRICKS DR",
            "address_2": "SUITE 401",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034527",
            "telephone_number": "301-870-6717",
            "fax_number": "301-870-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLARTA",
        "first_name": "KRISTINE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-27",
        "last_updated": "2019-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "21032",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305213251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404485100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINE",
            "last_name": "BOMEDIANO",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; 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.