Active NPI
Raquel Marie Wise, PTA
- Physical Therapy Assistant
- Alliance, OH
National Provider Identifier
1063661312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA - 07048
- Practice address
- 2484 W State St
Alliance, OH 44601-5608 - Phone
- (330) 829-2338
- Fax
- (330) 829-2376
- NPI assigned
- Sep 11, 2008
- 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 | PTA - 07048 | OH | Primary |
Addresses
Primary practice location
2484 W State St
Alliance, OH 44601-5608
Mailing address
4645 Belpar St NW
Canton, OH 44718-3602
Phone (330) 493-4210
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 |
|---|---|---|---|
| PTA - 07048 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221264000000",
"number": "1063661312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4645 BELPAR ST NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447183602",
"telephone_number": "330-493-4210",
"fax_number": "330-493-4744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2484 W STATE ST",
"city": "ALLIANCE",
"state": "OH",
"postal_code": "446015608",
"telephone_number": "330-829-2338",
"fax_number": "330-829-2376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "RAQUEL",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-11",
"last_updated": "2008-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "PTA - 07048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alliance, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.