Active NPI
Keith Pennetti, PT
- Physical Therapist
- Los Angeles, CA
National Provider Identifier
1629024963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 11500 Nimitz Ave
Los Angeles, CA 90049-3566 - Phone
- (631) 413-1648
- Fax
- (760) 242-1066
- NPI assigned
- May 26, 2006
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
11500 Nimitz Ave
Los Angeles, CA 90049-3566
Mailing address
11500 Nimitz Ave
Los Angeles, CA 90049-3566
Phone (631) 413-1648
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10491538 | Other | NY | CAQH |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path | Physical Therapist | Past | Accepting new patients |
| RPM Rebah, Inc | Physical Therapist | Past | Accepting new patients |
| Clinica Sierra Vista | Past | Accepting new patients | |
| RPM Rehab Inc | Past | Accepting new patients | |
| RPM Rehab, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 5
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.
-
dba Desert Physical Therapy and Sports Medicine
- Physical Therapist
- Apple Valley, CA
- NPI 1508151945
-
- Physical Therapist
- Harrison, NY
- NPI 1396799409
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355961600000",
"number": "1629024963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11500 NIMITZ AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900493566",
"telephone_number": "631-413-1648",
"fax_number": "760-242-1066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11500 NIMITZ AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900493566",
"telephone_number": "631-413-1648",
"fax_number": "760-242-1066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNETTI",
"first_name": "KEITH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2012-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10491538",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.