Kristy Lauren Ewert, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

39757 Issued in CA

Practice address

220 Greenfield Ave
San Anselmo, CA 94960-2416

Phone

(415) 457-4454

Fax

(415) 457-4944

NPI assigned

Jul 26, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Sport & Spine Therapy of Marin Inc

  • Orthopedic Physical Therapist
  • San Anselmo, CA
  • NPI 1154388577
  NPD (past)
• Sport & Spine Therapy of Marin Inc

  • Orthopedic Physical Therapist
  • Novato, CA
  • NPI 1174578199
  NPD (past)

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

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1770839839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 GREENFIELD AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602416",
            "telephone_number": "415-457-4454",
            "fax_number": "415-457-4944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 GREENFIELD AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602416",
            "telephone_number": "415-457-4454",
            "fax_number": "415-457-4944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWERT",
        "first_name": "KRISTY",
        "middle_name": "LAUREN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-26",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "39757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "99 Montecillo Rd",
            "city": "San Rafael",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949033308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alma Dunstan-McDaniel, MFT
• Travis Peter Duro, P.T., D.P.T., MPT
• Michael Durphy, M.D.
• Susan Edelstein, PHD
• Lucrecia Gloria Espejo, DDS
• Susan Ezra, RN
• Bruce Arlen Fabric, MD
• Carol Elizabeth Fabric, MFT
• Liza Fartash, D.D.S.
• Grant Finn

• Physical Therapist in San Anselmo, CA
• Providers in San Anselmo, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.