Derek Bennett

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT019053 Issued in OH

Practice address

2390 Rix Mills Rd
New Concord, OH 43762-9786

Phone

(740) 683-5081

NPI assigned

Feb 16, 2021

Last updated

Aug 1, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• 740 Performance Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • New Concord, OH
  • NPI 1336864099
  NPD Authorized official

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

{
    "created_epoch": "1613433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1144813676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2390 RIX MILLS RD",
            "city": "NEW CONCORD",
            "state": "OH",
            "postal_code": "437629786",
            "telephone_number": "740-683-5081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2390 RIX MILLS RD",
            "city": "NEW CONCORD",
            "state": "OH",
            "postal_code": "437629786",
            "telephone_number": "740-683-5081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "DEREK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-16",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT019053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 740 Performance Physical Therapy LLC
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• Alicia Jean Beynon, LISW-S, LICDC-CS
• Kenneth Blood, ATC
• Body Mechanic Physical Therapy
• Caralee Barr
• Care Equip, LLC (Northside New Concord Pharmacy)

• Physical Therapist in New Concord, OH
• Providers in New Concord, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; 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.