Mary Elizabeth Boedeker, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070.021261 Issued in IL

Practice address

144 Lincoln Place CT
Belleville, IL 62221-5878

Phone

(618) 233-5163

NPI assigned

Mar 10, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL, MO2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Apex Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Ballwin, MO
  • NPI 1295929644

  MO, Physical Therapist

  Medicare reassignment NPD
• P2 Enterprises, LLC

  • Physical Therapist
  • Saint Louis, MO
  • NPI 1013380443

  MO, Physical Therapist

  Medicare reassignment NPD
• Apex Physical Therapy, LLC

  • Specialist
  • Highland, IL
  • NPI 1033166061

  Physical Therapist

  NPD
• Apex Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Centerton, AR
  • NPI 1710732607

  Physical Therapist

  NPD
• P2 Enterprises, LLC

  • Physical Therapist
  • Brentwood, MO
  • NPI 1326414806
  NPD (past)

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

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1780077123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 APEX DR",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491282",
            "telephone_number": "618-651-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 LINCOLN PLACE CT",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622215878",
            "telephone_number": "618-233-5163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEDEKER",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-10",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2008013230",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.021261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Bobbitt, MSW
• Shana Marie Bobbitt, LPC
• Dana Bock, LCSW
• Sarah Marie Bocock, M.S.
• Ryan Boeckmann
• John J Boeren, MD
• James R Boivin, MD
• Tujohnna Chanel Bolton-Young, LPC
• Alexander Richard Bolton, D.O.
• Naveen Kumar Reddy Bondalapati, M.D.

• All providers in Belleville, IL
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; 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.