Active NPI
Matthew Bennett
- Orthopedic Physical Therapist
- Austin, TX
National Provider Identifier
1639583271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 1242529
- Practice address
- 6818 Austin Center Blvd Ste 111
Austin, TX 78731-3199 - Phone
- (512) 418-8870
- NPI assigned
- Jun 11, 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 1242529 | TX | Primary |
Addresses
Primary practice location
6818 Austin Center Blvd Ste 111
Austin, TX 78731-3199
Mailing address
6607 Brodie LN Apt 1223
Austin, TX 78745-4655
Phone (512) 538-5352
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124529 | Other | TX | TEXAS PT LICENSE |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1242529 | TX | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402444800000",
"number": "1639583271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6607 BRODIE LN APT 1223",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787454655",
"telephone_number": "512-538-5352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6818 AUSTIN CENTER BLVD STE 111",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787313199",
"telephone_number": "512-418-8870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-11",
"last_updated": "2014-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "TX",
"license": "1242529",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS PT LICENSE",
"identifier": "124529",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.