Individual provider Active NPI

Keraloos Abdelmessih, PT, DPT, CSCS

  • Orthopedic Physical Therapist
  • Rochester, NY
National Provider Identifier
1679175178
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
046483 Issued in NY
Practice address
4901 Lac de Ville Blvd Ste 110
Rochester, NY 14618-5648
Phone
(585) 341-9200
NPI assigned
Nov 10, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 046483 NY Primary

Addresses

Primary practice location

4901 Lac de Ville Blvd Ste 110
Rochester, NY 14618-5648

Mailing address

4901 Lac de Ville Blvd Ste 110
Rochester, NY 14618-5648

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

State licenses

LicenseStateTypeSpecialty
046483NYMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Strive2Move PastSince Dec 6, 2021 Accepting new patients

Organizations & group practices 1

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": "1604966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1679175178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 LAC DE VILLE BLVD STE 110",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146185648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 LAC DE VILLE BLVD STE 110",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146185648",
            "telephone_number": "585-341-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDELMESSIH",
        "first_name": "KERALOOS",
        "credential": "PT, DPT, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-10",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NY",
            "license": "046483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.