Active NPI
Judd West Wilson
- Physical Therapist
- Fayetteville, NC
National Provider Identifier
1194083709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P12366
- Practice address
- 1702 Owen Dr
Fayetteville, NC 28304-3419 - Phone
- (910) 323-3184
- NPI assigned
- May 2, 2012
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P12366 | NC | Primary |
Addresses
Primary practice location
1702 Owen Dr
Fayetteville, NC 28304-3419
Mailing address
2313 Old Henson Cove Rd
Canton, NC 28716-6872
Phone (828) 593-9660
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335916800000",
"number": "1194083709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2313 OLD HENSON COVE RD",
"city": "CANTON",
"state": "NC",
"postal_code": "287166872",
"telephone_number": "828-593-9660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1702 OWEN DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043419",
"telephone_number": "910-323-3184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JUDD",
"middle_name": "WEST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-05-02",
"last_updated": "2012-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P12366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.