Active NPI
David Bengry, DPT
- Physical Therapist
- Grand Rapids, MI
National Provider Identifier
1417357039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501016775
- Practice address
- 4120 E Beltline Ave NE
Suite 200
Grand Rapids, MI 49525-9655 - Phone
- (616) 365-2709
- Fax
- (616) 554-3079
- NPI assigned
- Sep 2, 2014
- 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 Therapist | 225100000X | 5501016775 | MI | Primary |
Addresses
Primary practice location
4120 E Beltline Ave NE
Suite 200
Grand Rapids, MI 49525-9655
Mailing address
4761 Lake Michigan Dr NW
Suite a
Grand Rapids, MI 49534-6300
Phone (616) 608-9978
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 |
|---|---|---|---|
| 5501016775 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564012800000",
"number": "1417357039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4761 LAKE MICHIGAN DR NW",
"address_2": "SUITE A",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495346300",
"telephone_number": "616-608-9978",
"fax_number": "616-554-3079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 E BELTLINE AVE NE",
"address_2": "SUITE 200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495259655",
"telephone_number": "616-365-2709",
"fax_number": "616-554-3079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENGRY",
"first_name": "DAVID",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-02",
"last_updated": "2019-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501016775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.