Skyfall Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SKYFALL PHYSICAL THERAPY

Practice address

11677 San Vicente Blvd Ste 207
Los Angeles, CA 90049-5128

Phone

(310) 743-6649

NPI assigned

Jul 13, 2017

Organization subpart

No

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

Authorized official

Name

Theresa Ketterhagen, PTNPI 1235460767

Title

President

Phone

(310) 743-6649

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theresa Ketterhagen, PT

  • Physical Therapist
  • Los Angeles, CA
  • NPI 1235460767
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1982126728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 491471",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900499471",
            "telephone_number": "310-743-6649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11677 SAN VICENTE BLVD STE 207",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495128",
            "telephone_number": "310-743-6649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYFALL PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-13",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A",
        "authorized_official_last_name": "KETTERHAGEN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-743-6649",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Skura Zedeck, R.N.
• Christy Lynn Skura, DPT, PCS
• Boris Skuratovich
• Sky Diagnostics, Inc.
• Boris M Skyar, M.D.
• Skyline Healthcare & Wellness Center, LLC
• Skyline Recovery Center
• Skyline Sleep Center Apc
• Brian Skyy, DPT
• Ginger C Slack

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.