Alia J Wantuch, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA30714 Issued in FL

Practice address

4606 Clyde Morris Blvd Ste 1D
Port Orange, FL 32129-7453

Phone

(386) 492-2986

NPI assigned

Nov 23, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Pro-Motion Physical Therapy of Volusia Cty

  • Physical Therapist
  • Port Orange, FL
  • NPI 1386895050
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1164026902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 CREEKWATER BLVD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321284088",
            "telephone_number": "386-871-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4606 CLYDE MORRIS BLVD STE 1D",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321297453",
            "telephone_number": "386-492-2986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANTUCH",
        "first_name": "ALIA",
        "middle_name": "J",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA30714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Wallingford
• Erin Rose Walls
• Cathleen Walsh, PTA
• Joanne Walter, PT
• Patricia Walters
• Cassandra Nichole Warner, APRN
• Heather Rose Watkins, LMT
• James W Weaver, M.D.
• Aaron Webb, D.C.
• Keith Weible

• Physical Therapy Assistant in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.

Verify at the official NPI Registry.