Individual provider Active NPI

Marykay Holmes, PTA

  • Physical Therapy Assistant
  • Willowbrook, IL
National Provider Identifier
1235416132
Registry record updated Nov 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
160004887 Issued in IL
Practice address
94 63Rd St
Willowbrook, IL 60527-2982
Phone
(630) 850-7901
NPI assigned
Nov 7, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 160004887 IL Primary

Addresses

Primary practice location

94 63Rd St
Willowbrook, IL 60527-2982

Mailing address

6200 Osage Ave
Downers Grove, IL 60516-2031
Phone (630) 915-6257

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

LicenseStateTypeSpecialty
160004887ILMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320624000000",
    "number": "1235416132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 OSAGE AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605162031",
            "telephone_number": "630-915-6257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 63RD ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605272982",
            "telephone_number": "630-850-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "MARYKAY",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-07",
        "last_updated": "2011-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160004887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willowbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.