Active NPI
Marybeth Grant-Beuttler, P.T., PH.D.
- Physical Therapist
- Corona del Mar, CA
National Provider Identifier
1720062813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 33373
- Practice address
- 19 Skysail Dr
Corona del Mar, CA 92625-1437 - Phone
- (949) 644-6460
- NPI assigned
- Dec 1, 2005
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 33373 | CA | Primary |
| Neurology Physical Therapist | 2251N0400X | 33373 | CA | |
| Pediatric Physical Therapist | 2251P0200X | 33373 | CA | |
| Rehabilitation Practitioner | 225400000X | 33373 | CA |
Addresses
Primary practice location
19 Skysail Dr
Corona del Mar, CA 92625-1437
Mailing address
19 Skysail Dr
Corona del Mar, CA 92625-1437
Phone (949) 644-6460
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163623 | Other | PA | MEDPLUS |
| 3742484 | Other | PW | AETNA HMO |
| BE1698593 | Other | PA | HIGHMARK |
| 819328 | Other | PA | FIRST PRIORITY/BC/BS |
| 9384434 | Other | PA | PHCS |
| 7780635 | Other | PA | AETNA PPO |
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
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192147200000",
"number": "1720062813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 SKYSAIL DR",
"city": "CORONA DEL MAR",
"state": "CA",
"postal_code": "926251437",
"telephone_number": "949-644-6460",
"fax_number": "570-489-5563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 SKYSAIL DR",
"city": "CORONA DEL MAR",
"state": "CA",
"postal_code": "926251437",
"telephone_number": "949-644-6460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT-BEUTTLER",
"first_name": "MARYBETH",
"name_prefix": "Dr.",
"credential": "P.T., PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-01",
"last_updated": "2007-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "33373",
"primary": true
},
{
"code": "2251N0400X",
"taxonomy_group": "",
"desc": "Physical Therapist, Neurology",
"state": "CA",
"license": "33373",
"primary": false
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "CA",
"license": "33373",
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "33373",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDPLUS",
"identifier": "163623",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "3742484",
"state": "PW"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK",
"identifier": "BE1698593",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST PRIORITY/BC/BS",
"identifier": "819328",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS",
"identifier": "9384434",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "7780635",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corona del Mar, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.