Kerwin Noel Payabyab Custodio, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1190952 Issued in TX

Practice address

2600 Eldorado Pkwy Ste 130
McKinney, TX 75070-7517

Phone

(972) 984-7670

Fax

(972) 984-7671

NPI assigned

Sep 19, 2011

Last updated

Dec 16, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elata Health and Wellness, LLCGroup PAC ID 8527359652, 6 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elata Health and Wellness, LLC

  dba Active Life Physical Therapy

  • Physical Therapist
  • McKinney, TX
  • NPI 1417311028
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1316390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1497037188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5716 CRAWLEY LN",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750711535",
            "telephone_number": "432-288-3974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 ELDORADO PKWY STE 130",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750707517",
            "telephone_number": "972-984-7670",
            "fax_number": "972-984-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTODIO",
        "first_name": "KERWIN NOEL",
        "middle_name": "PAYABYAB",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-19",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": "TX",
            "license": "1190952",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TX",
            "license": "1190952",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1190952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cure RX, LLC
• Kathleen M Curran, LMHC
• Curtis Medical PLLC (Horizon Eye Center)
• Custer Dental and Orthodontics, PLLC
• Custer Medical Clinic PLLC (Custer Family Clinic)
• Maria Catherine Yazon Custodio, PT
• Custom Dental of McKinney, PLLC
• CVS Pharmacy Inc (CVS Pharmacy # 05799)
• CVS Pharmacy Inc (CVS Pharmacy # 08321)
• CVS Pharmacy Inc (CVS Pharmacy # 05952)

• Physical Therapist in McKinney, TX
• Providers in McKinney, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; 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.