Active NPI
Jeffrey Martin Betonio, DPT
- Physical Therapist
- Saint Louis, MO
National Provider Identifier
1073070108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2019003954
- Practice address
- 401 Corporate Park Dr
Saint Louis, MO 63105-4201 - Phone
- (314) 725-7447
- NPI assigned
- Feb 25, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2019003954 | MO | Primary |
Addresses
Primary practice location
401 Corporate Park Dr
Saint Louis, MO 63105-4201
Mailing address
2266 Rule Ave Apt D
Maryland Heights, MO 63043-1430
Phone (901) 828-3789
Other names 1
- Jeffrey Betonio
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019003954 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551052800000",
"number": "1073070108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2266 RULE AVE APT D",
"city": "MARYLAND HEIGHTS",
"state": "MO",
"postal_code": "630431430",
"telephone_number": "901-828-3789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 CORPORATE PARK DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631054201",
"telephone_number": "314-725-7447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETONIO",
"first_name": "JEFFREY MARTIN",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-25",
"last_updated": "2019-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2019003954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JEFFREY",
"last_name": "BETONIO",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.