Active NPI
William Ellerd Dierks, PHYSICAL THERAPIST
- Physical Therapist
- Joplin, MO
National Provider Identifier
1093927618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 00733
- Practice address
- 3105 MC Clelland Blvd
Suite 101
Joplin, MO 64804-1640 - Phone
- (417) 623-5560
- Fax
- (417) 634-5740
- NPI assigned
- May 4, 2007
- Sex
- Male
- 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 Therapist | 225100000X | 00733 | MO | Primary |
Addresses
Primary practice location
3105 MC Clelland Blvd
Suite 101
Joplin, MO 64804-1640
Mailing address
3105 MC Clelland Blvd
Suite 101
Joplin, MO 64804-1640
Phone (417) 623-5560
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 |
|---|---|---|---|
| 00733 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093927618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3105 MC CLELLAND BLVD",
"address_2": "SUITE 101",
"city": "JOPLIN",
"state": "MO",
"postal_code": "648041640",
"telephone_number": "417-623-5560",
"fax_number": "417-623-5740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3105 MC CLELLAND BLVD",
"address_2": "SUITE 101",
"city": "JOPLIN",
"state": "MO",
"postal_code": "648041640",
"telephone_number": "417-623-5560",
"fax_number": "417-634-5740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIERKS",
"first_name": "WILLIAM",
"middle_name": "ELLERD",
"name_prefix": "Mr.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "00733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joplin, MO
Sources for this page
- 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.