Active NPI
Wendy Wilson
- Physical Therapy Assistant
- Roswell, NM
National Provider Identifier
1023314853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06001423A
- Practice address
- 1601 S Main St
Roswell, NM 88203-5436 - Phone
- (575) 623-6008
- NPI assigned
- Jan 26, 2011
- 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 Therapy Assistant | 225200000X | 06001423A | IN | Primary |
Addresses
Primary practice location
1601 S Main St
Roswell, NM 88203-5436
Mailing address
5625 N Red Oak Dr
Greenfield, IN 46140-8757
Phone (765) 524-2407
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 |
|---|---|---|---|
| 06001423A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296000000000",
"number": "1023314853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5625 N RED OAK DR",
"city": "GREENFIELD",
"state": "IN",
"postal_code": "461408757",
"telephone_number": "765-524-2407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 S MAIN ST",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882035436",
"telephone_number": "575-623-6008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "WENDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-26",
"last_updated": "2011-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06001423A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.