Active NPI
Michelle Wieman, PTA
- Physical Therapy Assistant
- Viborg, SD
National Provider Identifier
1235232125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 0044
- Practice address
- 315 N Washington Street
Viborg, SD 57070-0368 - Phone
- (605) 326-5161
- Fax
- (605) 326-5734
- NPI assigned
- Sep 6, 2006
- 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 | 0044 | SD | Primary |
Addresses
Primary practice location
315 N Washington Street
Viborg, SD 57070-0368
Mailing address
44760 273Rd St
Marion, SD 57043-5501
Phone (605) 297-4240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5833640 | Medicaid | SD |
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 |
|---|---|---|---|
| 0044 | SD | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235232125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44760 273RD ST",
"city": "MARION",
"state": "SD",
"postal_code": "570435501",
"telephone_number": "605-297-4240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 N WASHINGTON STREET",
"city": "VIBORG",
"state": "SD",
"postal_code": "570700368",
"telephone_number": "605-326-5161",
"fax_number": "605-326-5734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEMAN",
"first_name": "MICHELLE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "SD",
"license": "0044",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5833640",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Viborg, SD
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.