Active NPI
Timothy Grey Wilson, PT
- Physical Therapist
- Phoenix, AR
National Provider Identifier
1285897595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1782
- Practice address
- 7540 North 19TH Avenue
#200
Phoenix, AR 85021 - Phone
- (888) 873-4221
- Fax
- (888) 543-2289
- NPI assigned
- Jul 7, 2008
- 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 | 1782 | NC | Primary |
Addresses
Primary practice location
7540 North 19TH Avenue
#200
Phoenix, AR 85021
Mailing address
7540 North 19TH Avenue
#200
Phoenix, AR 85021
Phone (888) 873-4221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1980
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1 Pond St
Arden, NC 28704-8500
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1782 | NC | MD | Speech-Language Pathologist |
Organizations & group practices 1
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.
-
- Occupational Therapist
- Charlotte, NC
- NPI 1902317589
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215388800000",
"number": "1285897595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7540 NORTH 19TH AVENUE",
"address_2": "#200",
"city": "PHOENIX",
"state": "AR",
"postal_code": "85021",
"telephone_number": "888-873-4221",
"fax_number": "888-543-2289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7540 NORTH 19TH AVENUE",
"address_2": "#200",
"city": "PHOENIX",
"state": "AR",
"postal_code": "85021",
"telephone_number": "888-873-4221",
"fax_number": "888-543-2289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "TIMOTHY",
"middle_name": "GREY",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-07",
"last_updated": "2008-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "1782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.