Active NPI
Barbara Booth Wilson, ATC, LIC
- Specialist
- Saint Leo, FL
National Provider Identifier
1215133863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- AL 1066
- Practice address
- University Campus MC 2038 Saint Leo University
33701 St Rd 52
Saint Leo, FL 33574 - Phone
- (352) 588-8222
- NPI assigned
- Jun 21, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | AL 1066 | FL | Primary |
Addresses
Primary practice location
University Campus MC 2038 Saint Leo University
33701 St Rd 52
Saint Leo, FL 33574
Mailing address
25317 Tradewinds Dr
Land O Lakes, FL 34639-5563
Phone (813) 907-7414
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 |
|---|---|---|---|
| AL 1066 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215133863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25317 TRADEWINDS DR",
"city": "LAND O LAKES",
"state": "FL",
"postal_code": "346395563",
"telephone_number": "813-907-7414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "UNIVERSITY CAMPUS MC 2038 SAINT LEO UNIVERSITY",
"address_2": "33701 ST RD 52",
"city": "SAINT LEO",
"state": "FL",
"postal_code": "33574",
"telephone_number": "352-588-8222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BARBARA",
"middle_name": "BOOTH",
"credential": "ATC, LIC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "AL 1066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Leo, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.