Khampasong Haleudeth

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

25676 Issued in MA

Practice address

275 Mystic Ave Ste C
Medford, MA 02155-6301

Phone

(781) 874-9294

NPI assigned

Sep 20, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Boston Physical Therapy & Wellness, Inc

  • Physical Therapist
  • Medford, MA
  • NPI 1114315579
  Medicare reassignment NPD
• Massachusetts Luna Care Physical Therapy LLC

  • Physical Therapist
  • Boston, MA
  • NPI 1427713742
  Medicare reassignment NPD

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1992475081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 MYSTIC AVE STE C",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021556301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 MYSTIC AVE STE C",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021556301",
            "telephone_number": "781-874-9294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALEUDETH",
        "first_name": "KHAMPASONG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-20",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "25676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Hackley, D.M.D.
• Louise Haddock
• Georgia Hahn
• Bonni Ellen Haith
• Mohammad A Hakim, MD
• Irene Hall
• Joelle Hall
• Leonard Leroy Hall
• Sharon Hall, RNCS
• Hallmark Health

• Physical Therapist in Medford, MA
• Providers in Medford, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.