Active NPI
Julia B Wilson, PT
- Pediatric Physical Therapist
- Tulsa, OK
National Provider Identifier
1285633750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 481
- Practice address
- 4157 S Harvard Ave
#111
Tulsa, OK 74135-2631 - Phone
- (918) 712-7868
- Fax
- (918) 749-2901
- NPI assigned
- Jul 18, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 481 | OK | Primary |
Addresses
Primary practice location
4157 S Harvard Ave
#111
Tulsa, OK 74135-2631
Mailing address
4157 S Harvard Ave
#111
Tulsa, OK 74135-2631
Phone (918) 712-7868
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100663220E | Medicaid | OK | |
| 10228 | Other | OK | BLUE CROSS BLUE SHILED |
| 100663220C | Medicaid | OK | |
| 21824112 | Other | OK | AETNA |
| 200046900B | Medicaid | OK | |
| 4199540 | Other | OK | AETNA |
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 |
|---|---|---|---|
| 481 | OK | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208995200000",
"number": "1285633750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4157 S HARVARD AVE",
"address_2": "#111",
"city": "TULSA",
"state": "OK",
"postal_code": "741352631",
"telephone_number": "918-712-7868",
"fax_number": "918-749-2901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4157 S HARVARD AVE",
"address_2": "#111",
"city": "TULSA",
"state": "OK",
"postal_code": "741352631",
"telephone_number": "918-712-7868",
"fax_number": "918-749-2901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JULIA",
"middle_name": "B",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-07-18",
"last_updated": "2008-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "OK",
"license": "481",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100663220E",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHILED",
"identifier": "10228",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100663220C",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "21824112",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200046900B",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4199540",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.