Active NPI
Jody Warren Bethea, PT
- Physical Therapist
- Bonita, CA
National Provider Identifier
1992068142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT11267
- Practice address
- 4840 Butternut Hollow LN
Bonita, CA 91902-1717 - Phone
- (619) 972-5031
- NPI assigned
- Jun 22, 2012
- Sex
- Male
- 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 | PT11267 | CA | Primary |
Addresses
Primary practice location
4840 Butternut Hollow LN
Bonita, CA 91902-1717
Mailing address
4840 Butternut Hollow LN
Bonita, CA 91902-1717
Phone (619) 972-5031
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 |
|---|---|---|---|
| PT11267 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340323200000",
"number": "1992068142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4840 BUTTERNUT HOLLOW LN",
"city": "BONITA",
"state": "CA",
"postal_code": "919021717",
"telephone_number": "619-972-5031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4840 BUTTERNUT HOLLOW LN",
"city": "BONITA",
"state": "CA",
"postal_code": "919021717",
"telephone_number": "619-972-5031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETHEA",
"first_name": "JODY",
"middle_name": "WARREN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-22",
"last_updated": "2012-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT11267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonita, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.