Individual provider Active NPI

Bert Ryan Reitsma, PT

  • Physical Therapist
  • Chipley, FL
National Provider Identifier
1760557094
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT13831 Issued in FL
Practice address
1567 Main St
Chipley, FL 32428-6948
Phone
(850) 638-3387
Fax
(850) 415-1967
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2421 MN
Physical Therapist 225100000X PT13831 FL Primary

Addresses

Primary practice location

1567 Main St
Chipley, FL 32428-6948

Mailing address

32 Howell Bluff Rd
Ponce de Leon, FL 32455-4632
Phone (941) 228-9134

Other practice location 1

32 Howell Bluff Rd
Ponce DE Leon, FL 32455-4632
Phone (941) 228-9134

Other identifiers 1

IdentifierTypeStateIssuer
2421OtherMNPT LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040608000396 FL Practitioner - Physical Therapist in Private Practice 7012990583 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of Minnesota Medical School, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chipley Physical Therapy IncGroup PAC ID 1355319377, 3 clinicians
Marianna Physical and Aquatic Therapy LLCGroup PAC ID 1254721319, 2 clinicians

Practice addresses (Care Compare)

1567 Main St
Chipley, FL 32428-6948
Phone 8506383387105

4285 Lafayette St
Marianna, FL 32446-2919
Phone (850) 482-0080

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT13831FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Marianna Physical & Aquatic Therapy LLC Physical Therapist CurrentSince Sep 17, 2024 Accepting new patients
Chipley Physical Therapy, Inc Physical Therapist CurrentSince Sep 17, 2024 Accepting new patients
Chipley Physical Therapy Inc Physical Therapist CurrentSince Sep 17, 2024 Accepting new patients
Absolute Physical & Aquatic Therapy, LLC Physical Therapist CurrentSince Sep 17, 2024 Accepting new patients
Well Body Clinic Inc Physical Therapist Past Accepting new patients
United Outreach Inc Physical Therapist Past Accepting new patients

Locations

1567 Main St
Chipley, FL 32428
Phone (850) 638-3387

4285 Lafayette St
Marianna, FL 32446
Phone (850) 482-0080

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1760557094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 HOWELL BLUFF RD",
            "city": "PONCE DE LEON",
            "state": "FL",
            "postal_code": "324554632",
            "telephone_number": "941-228-9134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1567 MAIN ST",
            "city": "CHIPLEY",
            "state": "FL",
            "postal_code": "324286948",
            "telephone_number": "850-638-3387",
            "fax_number": "850-415-1967"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32 Howell Bluff Rd",
            "address_purpose": "LOCATION",
            "city": "Ponce DE Leon",
            "state": "FL",
            "postal_code": "324554632",
            "country_code": "US",
            "telephone_number": "941-228-9134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REITSMA",
        "first_name": "BERT",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "2421",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT13831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "2421",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chipley, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.