Active NPI
Bethany Dale Wirsig, DPT
- Physical Therapist
- Lees Summit, MO
National Provider Identifier
1598023301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2012023674
- Practice address
- 3747 SW Raintree Dr
Lees Summit, MO 64082-4606 - Phone
- (816) 537-5650
- Fax
- (816) 537-5649
- NPI assigned
- Apr 30, 2012
- 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 | 2012023674 | MO | Primary |
Addresses
Primary practice location
3747 SW Raintree Dr
Lees Summit, MO 64082-4606
Mailing address
17134 Bel Ray PL
Belton, MO 64012-5331
Phone (816) 226-4011
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47471021 | Other | BCBS KC | |
| MA4370034 | Other | MO | MEDICARE PTAN |
Other names 1
- Bethany Dale Morelock
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 |
|---|---|---|---|
| 2012023674 | MO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid America Balance Institute of Cass County Missouri | Past | Accepting new patients | |
| Spine and Extremity Rehabilitation Center of Raytown Inc | 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 and National Provider Directory roles.
-
- Respiratory/Developmental/Rehabilitative Specialist/Technologist
- Belton, MO
- NPI 1902050511
-
- Physical Therapist
- Raytown, MO
- NPI 1568410165
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392595200000",
"number": "1598023301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17134 BEL RAY PL",
"city": "BELTON",
"state": "MO",
"postal_code": "640125331",
"telephone_number": "816-226-4011",
"fax_number": "816-524-6115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3747 SW RAINTREE DR",
"city": "LEES SUMMIT",
"state": "MO",
"postal_code": "640824606",
"telephone_number": "816-537-5650",
"fax_number": "816-537-5649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIRSIG",
"first_name": "BETHANY",
"middle_name": "DALE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-30",
"last_updated": "2014-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2012023674",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS KC",
"identifier": "47471021",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "MA4370034",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "BETHANY",
"last_name": "MORELOCK",
"middle_name": "DALE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lees Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.