Mark Willemen, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 21015 Issued in FL

Practice address

495 22ND PL
Vero Beach, FL 32960-6002

Phone

(772) 567-8585

Fax

(772) 299-7868

NPI assigned

Sep 21, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Motion Therapeutic Massage, Inc

  • Rehabilitation Clinic/Center
  • Vero Beach, FL
  • NPI 1063571982
  NPD (past)
• Willemen Physical Therapy PC

  • Physical Therapist
  • Greenlawn, NY
  • NPI 1376618587
  NPD (past)

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190332800000",
    "number": "1265628366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 51ST CT",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329662340",
            "telephone_number": "772-643-5993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 22ND PL",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329606002",
            "telephone_number": "772-567-8585",
            "fax_number": "772-299-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLEMEN",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-21",
        "last_updated": "2007-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 21015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "PT 21015",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Asoka Wijetilleke
• Kristen Marie Wild, DMD
• Kaleigh Wilder, RBT
• Talmadge Dewitt Wilkins IV, DMD
• Kristen Wilkinson
• Jennifer Willenbrock
• Ashley Elizabeth Willer, OTR
• William E Riehl Jr OD Professional Association
• William J McCormack MD PA
• William J. Mallon, MD

• Physical Therapist in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.

Verify at the official NPI Registry.