NPIMap

Organization Active NPI

Pro Physical Therapy LLC

Doing business as PRO Physical Therapy

  • Physical Therapy Clinic/Center
  • Benton, KY
National Provider Identifier
1457026171
Registry record updated Dec 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PRO PHYSICAL THERAPY LLC
Doing business as
PRO Physical Therapy
Practice address
302 US Highway 68 W
Benton, KY 42025
Phone
(314) 277-9718
NPI assigned
Aug 13, 2021
Last updated
Dec 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2022

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

Authorized official

Name
Jani L Brewer, PTNPI 1366629354
Title
Owner
Phone
(270) 252-7600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

302 US Highway 68 W
Benton, KY 42025

Mailing address

302 US Highway 68 W
Benton, KY 42025-7797
Phone (314) 277-9718

Other names 1

  • PRO Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220107000711 KY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1658762331 Receives reassigned benefits from 3 practitioners
Practice locations: Benton, KY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670284800000",
    "number": "1457026171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 US HIGHWAY 68 W",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420257797",
            "telephone_number": "314-277-9718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 US HIGHWAY 68 W",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "42025",
            "telephone_number": "314-277-9718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-13",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "JANI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-252-7600",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRO Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRO Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; 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.

Verify at the official NPI Registry.