Miranda Jo Kerbawy, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

294488 Issued in CA

Practice address

325 Main St
El Segundo, CA 90245-3814

Phone

(310) 648-3167

Fax

(310) 648-3175

NPI assigned

Feb 19, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier RehabilitationGroup PAC ID 5698094795, 19 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 and National Provider Directory roles.

• Premier Rehabilitation

  • Physical Therapist
  • Holt, MI
  • NPI 1306244066

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1518998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518998400000",
    "number": "1538669239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 MAIN ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453814",
            "telephone_number": "310-648-3167",
            "fax_number": "310-648-3175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MAIN ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453814",
            "telephone_number": "310-648-3167",
            "fax_number": "310-648-3175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERBAWY",
        "first_name": "MIRANDA",
        "middle_name": "JO",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-19",
        "last_updated": "2018-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "294488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA",
            "identifier": "294488",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daishane Kendrix
• Jewel Kennedy
• Tanisha Kennedy
• Logan Kenny
• Daniel Kent
• Makayla Kerr
• Talisa Kerrigan
• Sonja Kerschner
• Hope Kerubo
• Denis Keshishyan

• Physical Therapist in El Segundo, CA
• Providers in El Segundo, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2018; 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.