Active NPI
M a Zurita Hernando Ibrahim, PT
- Physical Therapist
- Ravenswood, WV
National Provider Identifier
1427110717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 001137
- Practice address
- 240 Washington Street
Ravenswood, WV 26164 - Phone
- (304) 273-8071
- Fax
- (304) 273-8015
- NPI assigned
- Dec 14, 2006
- Sex
- Female
- 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 | 001137 | WV | Primary |
Addresses
Primary practice location
240 Washington Street
Ravenswood, WV 26164
Mailing address
240 Washington Street
PO Box 536
Ravenswood, WV 26164
Phone (304) 273-8071
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0157410000 | Medicaid | WV | |
| 0240071000 | 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1427110717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 WASHINGTON STREET",
"address_2": "PO BOX 536",
"city": "RAVENSWOOD",
"state": "WV",
"postal_code": "26164",
"telephone_number": "304-273-8071",
"fax_number": "304-273-8015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 WASHINGTON STREET",
"city": "RAVENSWOOD",
"state": "WV",
"postal_code": "26164",
"telephone_number": "304-273-8071",
"fax_number": "304-273-8015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "M A ZURITA",
"middle_name": "HERNANDO",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-14",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "001137",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0157410000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0240071000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ravenswood, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.