Active NPI
Jordan Benners, P.T
- Physical Therapist
- Mesquite, TX
National Provider Identifier
1346250388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1161172
- Practice address
- 2758 N Galloway Ave
Suite 100
Mesquite, TX 75150-6380 - Phone
- (972) 681-1155
- Fax
- (972) 681-3575
- NPI assigned
- Aug 9, 2006
- Last updated
- Feb 5, 2009
- Sex
- Female
- 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 Therapist | 225100000X | 1161172 | TX | Primary |
Addresses
Primary practice location
2758 N Galloway Ave
Suite 100
Mesquite, TX 75150-6380
Mailing address
2758 N Galloway Ave
Suite 100
Mesquite, TX 75150-6380
Phone (972) 681-1155
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1161172 | Other | TX | PHYSICAL THERAPY LICENSE |
| 8T8083 | Other | TX | BCBS |
Other names 1
- Jordan Byerly
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vista Rehab Partners, LP | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Vista Physical Therapy
- Multi-Specialty Clinic/Center
- Lake Worth, TX
- NPI 1326753377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233792000000",
"number": "1346250388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2758 N GALLOWAY AVE",
"address_2": "SUITE 100",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751506380",
"telephone_number": "972-681-1155",
"fax_number": "972-681-3575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2758 N GALLOWAY AVE",
"address_2": "SUITE 100",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751506380",
"telephone_number": "972-681-1155",
"fax_number": "972-681-3575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNERS",
"first_name": "JORDAN",
"credential": "P.T",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-09",
"last_updated": "2009-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1161172",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPY LICENSE",
"identifier": "1161172",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8T8083",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JORDAN",
"last_name": "BYERLY",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mesquite, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.