Individual provider Active NPI

Kezia M Wilson, DPT

  • Physical Therapist
  • Hamilton Township, NJ
National Provider Identifier
1649435082
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01359100 Issued in NJ
Practice address
1249 NJ-33
Suite 10
Hamilton Township, NJ 08690
Phone
(609) 964-7477
NPI assigned
Jul 24, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 030915 NY
Physical Therapist 225100000X 40QA01359100 NJ Primary

Addresses

Primary practice location

1249 NJ-33
Suite 10
Hamilton Township, NJ 08690

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (914) 294-4050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250304000543 NJ Practitioner - Physical Therapist in Private Practice 1951822295 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians

Practice addresses (Care Compare)

1249 Hwy 33
Suite 10
Hamilton, NJ 08690-2713
Phone (609) 964-7477

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
030915NYMDGeneral Practice Dentistry
40QA01359100NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist CurrentSince Feb 27, 2025 Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Feb 27, 2025 Accepting new patients

Locations

731 Lacey Rd
Ste 3
Forked River, NJ 08731
Phone (609) 242-6780

454 Passaic St
Hackensack, NJ 07601
Phone (201) 488-7905

1249 Highway 33
Ste 10
Trenton, NJ 08690
Phone (609) 964-7477

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

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.

NPI Registry JSON

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

{
    "created_epoch": "1216857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1649435082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1249 NJ-33",
            "address_2": "SUITE 10",
            "city": "HAMILTON TOWNSHIP",
            "state": "NJ",
            "postal_code": "08690",
            "telephone_number": "609-964-7477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KEZIA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-24",
        "last_updated": "2025-03-03",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "030915",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01359100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton Township, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; 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.