Active NPI
Jennifer Berwanger
- Physical Therapist
- Mesa, AZ
National Provider Identifier
1154780526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11892
- Practice address
- 7525 E Broadway Rd Ste 6
Mesa, AZ 85208-1156 - Phone
- (480) 354-2911
- Fax
- (480) 984-3169
- NPI assigned
- Feb 15, 2016
- Sex
- Female
- 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 | 11892 | AZ | Primary |
Addresses
Primary practice location
7525 E Broadway Rd Ste 6
Mesa, AZ 85208-1156
Mailing address
1234 Whitefish Stage
Kalispell, MT 59901-2753
Phone (406) 756-7878
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11892 | AZ | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| On the Mend on the Move Physical Therapy, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Mesa, AZ
- NPI 1528011178
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455494400000",
"number": "1154780526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1234 WHITEFISH STAGE",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599012753",
"telephone_number": "406-756-7878",
"fax_number": "406-309-2579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7525 E BROADWAY RD STE 6",
"city": "MESA",
"state": "AZ",
"postal_code": "852081156",
"telephone_number": "480-354-2911",
"fax_number": "480-984-3169"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERWANGER",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-15",
"last_updated": "2016-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "11892",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.