Gina Wiesbrock, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

96001397 Issued in IL

Practice address

1627 4TH St
Peru, IL 61354-3507

Phone

(815) 228-7939

NPI assigned

Mar 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• City Center Rehabilitation West - Inc.

  • Physical Therapy Clinic/Center
  • Peru, IL
  • NPI 1396981742
  NPD

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033241807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2227 STATE ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613543465",
            "telephone_number": "815-228-7939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 4TH ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613543507",
            "telephone_number": "815-228-7939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESBROCK",
        "first_name": "GINA",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "96001397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Ann Wallace, M.S.
• Walmart Inc.
• Wellness and Recovery With Maitri, Inc. NFP
• Christopher A Westphal, CRNA
• Shenyka Micole Wheatly, PA-C
• Anthony P Williams, OD
• Molly Williamson, RPT
• Karen Sue Windy
• Victoria Merritt Winterrose
• Robert Steven Wojcik Jr., M.D,

• Athletic Trainer in Peru, IL
• Providers in Peru, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.