MEDICARE: BETHANY RUTH NEWBERRY PTA, MT, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA21220	FL
2	133V00000X	Registered Dietitian	ND7755	FL

General Provider Information

NPI Number	:	1336417047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY RUTH NEWBERRY PTA, MT, RD

Provider Business Mailing Address
First Line	:	1102 S MISSOURI AVE APT 311
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-9160
Country	:	US
Telephone Number	:	407-758-5509
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 S MISSOURI AVE APT 311
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-9160
Country	:	US
Telephone Number	:	407-758-5509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	03/23/2026

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