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

Simone Khedaru, PT, DPT

Individual provider Physical Therapist · NPI 1528945177

Simone Khedaru, PT, DPT is a Physical Therapist in Private Practice in Astoria, New York. Qualified in 2025, 1 year ago. Practices with Soma Physical and Occupational Therapy PLLC, a 4-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
1
Licensed in
NY
In the registry since
2025
Specialties on file
2
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

25-29 Broadway
Astoria, NY 11106
Phone: (646) 347-0060
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 054975 (NY)
Physical Therapist Taxonomy 225100000X (NY)

Record details

NPI number1528945177
Entity typeIndividual (Type 1)
GenderNot disclosed
Credentials PT , DPT
Sole proprietorNo
NPI enumeratedAugust 18, 2025
Last updated in NPPESAugust 18, 2025
Certification dateAugust 18, 2025

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Soma Physical And Occupational Therapy Pllc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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