Active NPI
Brenda J Devenport, PT
- Physical Therapist
- Austintown, OH
National Provider Identifier
1942281183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 03968
- Practice address
- 1397 S Canfield Niles Rd
Unit 1
Austintown, OH 44515-4084 - Phone
- (330) 953-0129
- Fax
- (330) 953-0650
- NPI assigned
- Nov 5, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 03968 | OH | Primary |
Addresses
Primary practice location
1397 S Canfield Niles Rd
Unit 1
Austintown, OH 44515-4084
Mailing address
1397 S Canfield Niles Rd
Unit 1
Austintown, OH 44515-4084
Phone (330) 953-0129
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2361671 | Medicaid | OH | |
| 000000370465 | Other | OH | ANTHEM |
| DA4145763 | Other | OH | MEDICARE RAILROAD |
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 |
|---|---|---|---|
| 03968 | OH | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwoods Rehabilitation LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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": "1131148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480464000000",
"number": "1942281183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1397 S CANFIELD NILES RD",
"address_2": "UNIT 1",
"city": "AUSTINTOWN",
"state": "OH",
"postal_code": "445154084",
"telephone_number": "330-953-0129",
"fax_number": "330-953-0650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1397 S CANFIELD NILES RD",
"address_2": "UNIT 1",
"city": "AUSTINTOWN",
"state": "OH",
"postal_code": "445154084",
"telephone_number": "330-953-0129",
"fax_number": "330-953-0650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVENPORT",
"first_name": "BRENDA",
"middle_name": "J",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-05",
"last_updated": "2016-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "03968",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2361671",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000370465",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "DA4145763",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austintown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.