Active NPI
Benjamin Michael Wilt, PT, DPT, OCS
- Orthopedic Physical Therapist
- Gonzales, LA
National Provider Identifier
1265840516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 08810
- Practice address
- 13334 W Mill Grove Dr
Gonzales, LA 70737-6564 - Phone
- (337) 258-7127
- NPI assigned
- Jul 31, 2014
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 08810 | LA | Primary |
Addresses
Primary practice location
13334 W Mill Grove Dr
Gonzales, LA 70737-6564
Mailing address
13334 W Mill Grove Dr
Gonzales, LA 70737-6564
Phone (337) 258-7127
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 |
|---|---|---|---|
| 08810 | LA | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547596800000",
"number": "1265840516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13334 W MILL GROVE DR",
"city": "GONZALES",
"state": "LA",
"postal_code": "707376564",
"telephone_number": "337-258-7127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13334 W MILL GROVE DR",
"city": "GONZALES",
"state": "LA",
"postal_code": "707376564",
"telephone_number": "337-258-7127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILT",
"first_name": "BENJAMIN",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "PT, DPT, OCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-31",
"last_updated": "2019-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "LA",
"license": "08810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gonzales, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.