Amanda Wilson, A.A.S. PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2015027051 Issued in MO

Practice address

924 N Scott Ave
Belton, MO 64012-1739

Phone

(816) 331-0111

NPI assigned

Jan 13, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Applied Science

State licenses

Practice roles

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.

• Exercise Therapy Consultants, Inc.

  • Physical Therapist
  • Belton, MO
  • NPI 1962414250
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484265600000",
    "number": "1013453174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 MAVERICK CIR",
            "city": "PECULIAR",
            "state": "MO",
            "postal_code": "640789782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 N SCOTT AVE",
            "city": "BELTON",
            "state": "MO",
            "postal_code": "640121739",
            "telephone_number": "816-331-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMANDA",
        "credential": "A.A.S. PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-13",
        "last_updated": "2017-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2015027051",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KS",
            "license": "14-03118",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• White Crystal Emergency Physicians, LLC
• Scott Michael White, D.D.S.
• Rachele Wienecke, FNP
• Christine Williams
• David R Williams, MD
• Kimberly A Winkley, ARNP
• Wound Solutions of Kansas City LLC
• Wright Audiology and Hearing AIDS
• Trisha Xue
• Jacob David Young, D.D.S.

• All providers in Belton, MO
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.