Active NPI
Rylan Brooks Wilson
- Physical Therapy Assistant
- Indianapolis, IN
National Provider Identifier
1104705920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06007029A
- Practice address
- 1992 E Stop 13 Rd
Indianapolis, IN 46227-6267 - Phone
- (317) 808-0230
- NPI assigned
- Aug 27, 2025
- Last updated
- Oct 23, 2025
- 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 | 06007029A | IN | Primary |
Addresses
Primary practice location
1992 E Stop 13 Rd
Indianapolis, IN 46227-6267
Mailing address
33900 Harper Ave Ste 104
Clinton TWP, MI 48035-4258
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 |
|---|---|---|---|
| 06007029A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761177600000",
"number": "1104705920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33900 HARPER AVE STE 104",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480354258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1992 E STOP 13 RD",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462276267",
"telephone_number": "317-808-0230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "RYLAN",
"middle_name": "BROOKS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-08-27",
"last_updated": "2025-10-23",
"certification_date": "2025-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06007029A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.