Khail Edsel Ronquillo Velicaria

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

2838 E Atlanta Rd Ste 2
Ellenwood, GA 30294-2780

Phone

(678) 782-3609

NPI assigned

Aug 31, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Independent Physical Therapy of Georgia, LLCGroup PAC ID 2961312244, 526 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.

• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  Medicare reassignment Care Compare group NPD
• Benchmark Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Duluth, GA
  • NPI 1083666903
  Medicare reassignment NPD
• Benchmark Physical Therapy Inc

  • Physical Therapist
  • Riverdale, GA
  • NPI 1427000777
  NPD
• Independent Physical Therapy of Ga, LLC

  • Physical Therapist
  • Peachtree City, GA
  • NPI 1346780632
  NPD
• Independent Physical Therapy of Georgia, LLC

  • Occupational Therapist
  • Gainesville, GA
  • NPI 1306013941

  Physical Therapist

  NPD

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

{
    "created_epoch": "1693440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1780460279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2838 E ATLANTA RD STE 2",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942780",
            "telephone_number": "678-782-3609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELICARIA",
        "first_name": "KHAIL EDSEL",
        "middle_name": "RONQUILLO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-31",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "012282",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlene Turner, LCSW
• Eric Antwain Turner
• Joyce Ann Turner, NP
• Marlon Tyner, R.PH.
• Nancy Vance
• Wal-Mart Stores East LP
• Walgreen Co
• Kymberly Elizabeth Walker, EDD, LPC
• Lorie Warren, CNM
• We Care Adult Daycare Center Specializing in Dementia

• Physical Therapist in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; 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.