Active NPI
Patricia Wiesner, PT
- Physical Therapist
- O Fallon, IL
National Provider Identifier
1144322256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070003265
- Practice address
- 1567 Sinking Springs Dr
O Fallon, IL 62269-6658 - Phone
- (618) 632-9120
- Fax
- (618) 551-2697
- NPI assigned
- Sep 1, 2006
- Sex
- Female
- 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 Therapist | 225100000X | 070003265 | IL | Primary |
Addresses
Primary practice location
1567 Sinking Springs Dr
O Fallon, IL 62269-6658
Mailing address
PO Box 591
O Fallon, IL 62269-0591
Phone (618) 632-9120
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 |
|---|---|---|---|
| 070003265 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553731200000",
"number": "1144322256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 591",
"city": "O FALLON",
"state": "IL",
"postal_code": "622690591",
"telephone_number": "618-632-9120",
"fax_number": "618-551-2697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1567 SINKING SPRINGS DR",
"city": "O FALLON",
"state": "IL",
"postal_code": "622696658",
"telephone_number": "618-632-9120",
"fax_number": "618-551-2697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIESNER",
"first_name": "PATRICIA",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-01",
"last_updated": "2019-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070003265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.