Individual provider Active NPI

Emma Wilson

  • Physical Therapist
  • Evanston, IL
National Provider Identifier
1063384014
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.029535 Issued in IL
Practice address
2536 Ewing Ave
Evanston, IL 60201-1214
Phone
(847) 905-0332
NPI assigned
Sep 19, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070.029535 IL Primary

Addresses

Primary practice location

2536 Ewing Ave
Evanston, IL 60201-1214

Mailing address

1015 N Dunton Ave
Arlington Heights, IL 60004-5558

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251008002141 IL Practitioner - Physical Therapist in Private Practice 7214434968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sports and Ortho PCGroup PAC ID 5698676740, 31 clinicians

Practice addresses (Care Compare)

2536 Ewing Ave
Evanston, IL 60201-1214
Phone (847) 905-0332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.029535ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sports and Ortho P.C CurrentSince Jul 28, 2025 Accepting new patients

Locations

412 W 31st St
Chicago, IL 60616
Phone (312) 225-3119

2536 Ewing Ave
Evanston, IL 60201
Phone (847) 905-0332

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1758240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1063384014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 N DUNTON AVE",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600045558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2536 EWING AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011214",
            "telephone_number": "847-905-0332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "EMMA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-19",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.029535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.