Active NPI
Timothy S Sly, P.T.
- Physical Therapist
- Wadena, MN
National Provider Identifier
1245431055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4522
- Practice address
- 415 Jefferson St N
Wadena, MN 56482-1264 - Phone
- (218) 631-7475
- Fax
- (218) 632-8765
- NPI assigned
- May 30, 2007
- Last updated
- Jul 8, 2007
- 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 | 4522 | MN | Primary |
Addresses
Primary practice location
415 Jefferson St N
Wadena, MN 56482-1264
Mailing address
15642 Shady Acres Dr
Wadena, MN 56482-3018
Phone (218) 631-2025
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 |
|---|---|---|---|
| 4522 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245431055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15642 SHADY ACRES DR",
"city": "WADENA",
"state": "MN",
"postal_code": "564823018",
"telephone_number": "218-631-2025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 JEFFERSON ST N",
"city": "WADENA",
"state": "MN",
"postal_code": "564821264",
"telephone_number": "218-631-7475",
"fax_number": "218-632-8765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLY",
"first_name": "TIMOTHY",
"middle_name": "S",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "4522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wadena, MN
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.