Individual provider Active NPI

Maria Wondra, D.P.T.

  • Physical Therapist
  • Woodstock, IL
National Provider Identifier
1063955359
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.022437 Issued in IL
Practice address
840 N Seminary Ave
Woodstock, IL 60098-2951
Phone
(815) 338-2110
NPI assigned
Nov 18, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

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 070.022437 IL Primary

Addresses

Primary practice location

840 N Seminary Ave
Woodstock, IL 60098-2951

Mailing address

840 N Seminary Ave.
Woodstock, IL 60098
Phone (815) 338-2110

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220204001986 IL Practitioner - Physical Therapist in Private Practice 7719370220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christie Clinic, PLLCGroup PAC ID 7719899319, 219 clinicians

Practice addresses (Care Compare)

101 W University Ave
Champaign, IL 61820-3909
Phone (217) 366-1200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.022437ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Christie Clinic, PLLC Physical Therapist CurrentSince Jan 11, 2022 Accepting new patients
Brandon & Associates Physical Therapy Physical Therapist Current Accepting new patients

Locations

101 W University Ave
Champaign, IL 61820
Phone (217) 366-1255

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

Organizations & group practices 2

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": "1479427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1063955359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 N SEMINARY AVE.",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "60098",
            "telephone_number": "815-338-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 N SEMINARY AVE",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600982951",
            "telephone_number": "815-338-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONDRA",
        "first_name": "MARIA",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-18",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.022437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; 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.