Carol Bettendorf, PT

Primary specialty

SpecialistTaxonomy code 174400000X

License

070002049 Issued in IL

Practice address

89 Cedar Ave
Lake Villa, IL 60046-8411

Phone

(847) 265-7300

Fax

(847) 265-7301

NPI assigned

Feb 8, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Birth to Three & Beyond Pediatric Therapies, LLC

  dba The Therapy Tree, LLC

  • Professional Counselor
  • Lake Villa, IL
  • NPI 1063955847

  Multi-Specialty

  NPD (past)
• The Therapy Tree D.B.a. Birth to Three & Beyond Pediatric Therapies

  • Speech-Language Pathologist
  • Lake Villa, IL
  • NPI 1710047964

  Specialist

  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285027200000",
    "number": "1386784098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 764",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600460764",
            "telephone_number": "847-265-7300",
            "fax_number": "847-265-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 CEDAR AVE",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600468411",
            "telephone_number": "847-265-7300",
            "fax_number": "847-265-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTENDORF",
        "first_name": "CAROL",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2010-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "070002049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "04932271",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEIN",
            "identifier": "710957905",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Barry, RBT-17-45944
• Be Well Therapy, Inc.
• Teresa Marie Beckman, PT
• Brenda L Beitzel, OT
• Laura Ann Benton, PSY.D.
• Maral Binnebose, MSW
• Birth to Three & Beyond Pediatric Therapies, LLC (The Therapy Tree, LLC)
• Shaniqua Blackman
• Blending Families, Inc
• Blending Families, Inc.

• Specialist in Lake Villa, IL
• Providers in Lake Villa, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; 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.