Active NPI
Kerry Moran, PT
- Physical Therapist
- Roxbury Crossing, MA
National Provider Identifier
1851435309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 16568
- Practice address
- 125 Parker Hill Ave
Roxbury Crossing, MA 02120-2847 - Phone
- (617) 754-5500
- NPI assigned
- Feb 17, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 16568 | MA | Primary |
Addresses
Primary practice location
125 Parker Hill Ave
Roxbury Crossing, MA 02120-2847
Mailing address
35 Goethe St
West Roxbury, MA 02132-6327
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16568 | MA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851435309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 GOETHE ST",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021326327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 PARKER HILL AVE",
"city": "ROXBURY CROSSING",
"state": "MA",
"postal_code": "021202847",
"telephone_number": "617-754-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORAN",
"first_name": "KERRY",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "16568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxbury Crossing, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.