Active NPI
Jeremy Scott Berry, PTA
- Physical Therapy Assistant
- Trinidad, CO
National Provider Identifier
1124716444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 0014693
- Practice address
- 409 Benedicta Ave
Trinidad, CO 81082 - Phone
- (719) 846-9291
- NPI assigned
- Apr 25, 2023
- Sex
- Male
- Sole proprietor
- No
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 Therapy Assistant | 225200000X | 0014693 | CO | Primary |
Addresses
Primary practice location
409 Benedicta Ave
Trinidad, CO 81082
Mailing address
1606 Hayes Street
Trinidad, CO 81082
Phone (419) 309-0560
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 |
|---|---|---|---|
| 0014693 | CO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682380800000",
"number": "1124716444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1606 HAYES STREET",
"city": "TRINIDAD",
"state": "CO",
"postal_code": "81082",
"telephone_number": "419-309-0560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 BENEDICTA AVE",
"city": "TRINIDAD",
"state": "CO",
"postal_code": "81082",
"telephone_number": "719-846-9291"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY",
"first_name": "JEREMY",
"middle_name": "SCOTT",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-04-25",
"last_updated": "2023-04-25",
"certification_date": "2023-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CO",
"license": "0014693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Trinidad, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.