NPIMap

Individual provider Active NPI

Andrew C. Bennett, PT

  • Physical Therapist
  • Selma, TX
National Provider Identifier
1053428797
Registry record updated Oct 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1131118 Issued in TX
Practice address
8335 Agora Pkwy
Suite 100
Selma, TX 78154-1382
Phone
(210) 658-8483
Fax
(210) 658-0828
NPI assigned
Aug 25, 2006
Last updated
Oct 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1131118 TX Primary

Addresses

Primary practice location

8335 Agora Pkwy
Suite 100
Selma, TX 78154-1382

Mailing address

1324 Common St
Suite 307
New Braunfels, TX 78130-3565
Phone (830) 625-7310

Other identifiers 2

IdentifierTypeStateIssuer
8T2966OtherTXBC/BS
170506301MedicaidTX

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
1131118TXMDPhysical Therapist

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1053428797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1324 COMMON ST",
            "address_2": "SUITE 307",
            "city": "NEW BRAUNFELS",
            "state": "TX",
            "postal_code": "781303565",
            "telephone_number": "830-625-7310",
            "fax_number": "830-625-3228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8335 AGORA PKWY",
            "address_2": "SUITE 100",
            "city": "SELMA",
            "state": "TX",
            "postal_code": "781541382",
            "telephone_number": "210-658-8483",
            "fax_number": "210-658-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "ANDREW",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1131118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "8T2966",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170506301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Selma, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.