Active NPI
Steven Carl Wilson, RPT
- Physical Therapist
- Wichita, KS
National Provider Identifier
1235268558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11-00936
- Practice address
- 8404 W 13TH St N
BLDG D,#180
Wichita, KS 67212-2978 - Phone
- (316) 773-6327
- Fax
- (316) 773-6285
- NPI assigned
- Mar 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 11-00936 | KS | Primary |
Addresses
Primary practice location
8404 W 13TH St N
BLDG D,#180
Wichita, KS 67212-2978
Mailing address
24310 W 109TH Ter
Olathe, KS 66061-8852
Phone (913) 706-0362
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 481243012 | Other | KS | OTHER MANAGED CARE PLANS |
| 100417090A | Medicaid | KS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 936 | KS | MD | Mental Health Counselor |
| 11-00936 | KS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560902400000",
"number": "1235268558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24310 W 109TH TER",
"city": "OLATHE",
"state": "KS",
"postal_code": "660618852",
"telephone_number": "913-706-0362"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8404 W 13TH ST N",
"address_2": "BLDG D,#180",
"city": "WICHITA",
"state": "KS",
"postal_code": "672122978",
"telephone_number": "316-773-6327",
"fax_number": "316-773-6285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "STEVEN",
"middle_name": "CARL",
"credential": "RPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-04",
"last_updated": "2019-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "11-00936",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER MANAGED CARE PLANS",
"identifier": "481243012",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100417090A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.