Active NPI
Sandra Fatima Bettencourt-Mitchell, DPT
- Physical Therapist
- Vallejo, CA
National Provider Identifier
1821316506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 36273
- Practice address
- 975 Sereno Dr
Vallejo, CA 94589-2441 - Phone
- (707) 651-4786
- NPI assigned
- May 5, 2010
- 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 | 36273 | CA | Primary |
Addresses
Primary practice location
975 Sereno Dr
Vallejo, CA 94589-2441
Mailing address
3700 Lyon Rd
Apt.109
Fairfield, CA 94534-7972
Phone (530) 304-1149
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 |
|---|---|---|---|
| 36273 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371686400000",
"number": "1821316506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 LYON RD",
"address_2": "APT.109",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945347972",
"telephone_number": "530-304-1149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 SERENO DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945892441",
"telephone_number": "707-651-4786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETTENCOURT-MITCHELL",
"first_name": "SANDRA",
"middle_name": "FATIMA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-05",
"last_updated": "2013-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "36273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.