Active NPI
Jay David Wilson, DPT
- Physical Therapist
- Fargo, ND
National Provider Identifier
1104995604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 938
- Practice address
- 3101 Broadway N
Suite C
Fargo, ND 58102-1485 - Phone
- (701) 271-1000
- Fax
- (701) 526-3818
- NPI assigned
- Nov 7, 2006
- 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 | 938 | ND | Primary |
Addresses
Primary practice location
3101 Broadway N
Suite C
Fargo, ND 58102-1485
Mailing address
827 32ND Ave N
#108
Fargo, ND 58102-1087
Phone (701) 271-1000
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 938 | ND | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilson Physical Therapy | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Fargo, ND
- NPI 1851591150
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186444800000",
"number": "1104995604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "827 32ND AVE N",
"address_2": "#108",
"city": "FARGO",
"state": "ND",
"postal_code": "581021087",
"telephone_number": "701-271-1000",
"fax_number": "701-526-3818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3101 BROADWAY N",
"address_2": "SUITE C",
"city": "FARGO",
"state": "ND",
"postal_code": "581021485",
"telephone_number": "701-271-1000",
"fax_number": "701-526-3818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JAY",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-07",
"last_updated": "2007-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "938",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.