Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Khail Edsel Ronquillo Velicaria

Individual provider Physical Therapist · NPI 1780460279

Khail Edsel Ronquillo Velicaria is a Physical Therapist in Private Practice in Ellenwood, Georgia. Qualified in 2019, 7 years ago. Practices with Independent Physical Therapy of Georgia LLC, a 529-clinician group and accepts Medicare assignment. Licensed in Connecticut.

Years since qualifying
7
Licensed in
CT
In the registry since
2023
Specialties on file
2

Practice location Address checks out

2838 E Atlanta Rd Ste 2
Ellenwood, GA 30294-2780
Phone: (678) 782-3609
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X
Physical Therapist Taxonomy 225100000X · Licence 012282 (CT)

Record details

NPI number1780460279
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 31, 2023
Last updated in NPPESSeptember 27, 2023
Certification dateSeptember 27, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Independent Physical Therapy Of Georgia Llc — 529 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Ellenwood