Theo Wilson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

008444 Issued in CT

Practice address

16 Avery HTS
Hartford, CT 06106-4201

Phone

(347) 490-4333

NPI assigned

Nov 4, 2013

Sex

Male

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

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Life Home Therapy LLCGroup PAC ID 1254746340, 50 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Life Home Therapy LLC

  • Physical Therapist
  • Livingston, NJ
  • NPI 1467048777
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383523200000",
    "number": "1164851895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 AVERY HTS",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061064201",
            "telephone_number": "347-490-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 AVERY HTS",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061064201",
            "telephone_number": "347-490-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "THEO",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-04",
        "last_updated": "2013-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "008444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Wilson, MD
• Heather Lynne Wilson, APRN
• Kathryn E Wilson
• Niamey Susannah Wilson, MD
• Sweets Wilson, MSW, PH.D., LADC
• Emma Wentworth Winchester, DMD, PHD
• Mary Hyde Windels, MD
• Samantha Ann Windoloski, PA-C
• Katherine Anne Winiarski, MSW LCSW
• Katherine Grace Winiarski, LCSW

• Physical Therapist in Hartford, CT
• Providers in Hartford, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.