Active NPI
Tracy Alma Bettencourt, DPT
- Pediatric Physical Therapist
- Woodbridge, VA
National Provider Identifier
1972240091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 2305214986
- Practice address
- 2235 Tacketts Mill Dr Unit C
Woodbridge, VA 22192-3036 - Phone
- (703) 491-1044
- NPI assigned
- May 19, 2022
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 2305214986 | VA | Primary |
Addresses
Primary practice location
2235 Tacketts Mill Dr Unit C
Woodbridge, VA 22192-3036
Mailing address
2101 Mill Rd Apt 110
Alexandria, VA 22314-5318
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305214986 | VA | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Achievements, LLC | 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.
-
- Specialist
- Woodbridge, VA
- NPI 1720330277
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652918400000",
"number": "1972240091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 MILL RD APT 110",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223145318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2235 TACKETTS MILL DR UNIT C",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221923036",
"telephone_number": "703-491-1044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETTENCOURT",
"first_name": "TRACY",
"middle_name": "ALMA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-19",
"last_updated": "2022-05-19",
"certification_date": "2022-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "VA",
"license": "2305214986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbridge, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.