Active NPI
Crystal Renay Wiedl
- Physical Therapy Assistant
- Hillsville, VA
National Provider Identifier
1144836651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2306605452
- Practice address
- 222 Fulcher St
Hillsville, VA 24343-1633 - Phone
- (276) 728-2486
- NPI assigned
- Sep 20, 2020
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 2306605452 | VA | Primary |
Addresses
Primary practice location
222 Fulcher St
Hillsville, VA 24343-1633
Mailing address
6085 Stoney Fork Rd
Wytheville, VA 24382-5803
Phone (276) 620-0961
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 |
|---|---|---|---|
| 2306605452 | VA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600560000000",
"number": "1144836651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6085 STONEY FORK RD",
"city": "WYTHEVILLE",
"state": "VA",
"postal_code": "243825803",
"telephone_number": "276-620-0961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 FULCHER ST",
"city": "HILLSVILLE",
"state": "VA",
"postal_code": "243431633",
"telephone_number": "276-728-2486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDL",
"first_name": "CRYSTAL",
"middle_name": "RENAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-20",
"last_updated": "2020-09-20",
"certification_date": "2020-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "VA",
"license": "2306605452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hillsville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.