Active NPI
Gabriel Wilson, DPT
- Orthopedic Physical Therapist
- Fairmont, WV
National Provider Identifier
1124401963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- PT003494
- Practice address
- 719 Fairmont Ave
Suite 102
Fairmont, WV 26554-5118 - Phone
- (304) 363-8543
- Fax
- (304) 363-1073
- NPI assigned
- Jun 29, 2015
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | PT003494 | WV | Primary |
Addresses
Primary practice location
719 Fairmont Ave
Suite 102
Fairmont, WV 26554-5118
Mailing address
719 Fairmont Ave
Suite 102
Fairmont, WV 26554-5118
Phone (304) 363-8543
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 |
|---|---|---|---|
| PT003494 | WV | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435536000000",
"number": "1124401963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "719 FAIRMONT AVE",
"address_2": "SUITE 102",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265545118",
"telephone_number": "304-363-8543",
"fax_number": "304-363-1073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "719 FAIRMONT AVE",
"address_2": "SUITE 102",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "265545118",
"telephone_number": "304-363-8543",
"fax_number": "304-363-1073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "GABRIEL",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-29",
"last_updated": "2015-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "WV",
"license": "PT003494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.