Active NPI
Karissa Dawn Ly, PT, DPT
- Physical Therapist
- Canoga Park, CA
National Provider Identifier
1477090181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 38416
- Practice address
- 22122 Sherman Way
Suite 106
Canoga Park, CA 91303-1140 - Phone
- (818) 592-6030
- Fax
- (818) 592-6034
- NPI assigned
- Jan 20, 2017
- 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 | 38416 | CA | Primary |
Addresses
Primary practice location
22122 Sherman Way
Suite 106
Canoga Park, CA 91303-1140
Mailing address
325 Rolling Oaks Drive
Suite 210
Thousand Oaks, CA 91361-1088
Phone (805) 446-3141
Other names 1
- Karissa Dawn Immel
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
24441 Calle Sonora
Laguna Woods, CA 92637-7714
Phone (949) 243-5710
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Custom P.T., a Physical Therapy Corp | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Therapist
- Canoga Park, CA
- NPI 1043342397
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484870400000",
"number": "1477090181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 ROLLING OAKS DRIVE",
"address_2": "SUITE 210",
"city": "THOUSAND OAKS",
"state": "CA",
"postal_code": "913611088",
"telephone_number": "805-446-3141",
"fax_number": "805-446-3140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22122 SHERMAN WAY",
"address_2": "SUITE 106",
"city": "CANOGA PARK",
"state": "CA",
"postal_code": "913031140",
"telephone_number": "818-592-6030",
"fax_number": "818-592-6034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "KARISSA",
"middle_name": "DAWN",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-20",
"last_updated": "2017-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "38416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KARISSA",
"last_name": "IMMEL",
"middle_name": "DAWN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Canoga Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; 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.