Active NPI
Robert Wayne Long III, P.T.A.
- Physical Therapy Assistant
- Peru, IN
National Provider Identifier
1073998571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06005129A
- Practice address
- 275 W 12TH St
Peru, IN 46970-1638 - Phone
- (765) 472-8000
- NPI assigned
- Jul 25, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 | 06005129A | IN | Primary |
Addresses
Primary practice location
275 W 12TH St
Peru, IN 46970-1638
Mailing address
1452 Strawtown Pike
Peru, IN 46970-2775
Phone (765) 461-3938
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 |
|---|---|---|---|
| 06005129A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437782400000",
"number": "1073998571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1452 STRAWTOWN PIKE",
"city": "PERU",
"state": "IN",
"postal_code": "469702775",
"telephone_number": "765-461-3938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 W 12TH ST",
"city": "PERU",
"state": "IN",
"postal_code": "469701638",
"telephone_number": "765-472-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "ROBERT",
"middle_name": "WAYNE",
"name_suffix": "III",
"credential": "P.T.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-25",
"last_updated": "2015-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06005129A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peru, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.