Jeffrey David Wilson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0086361 Issued in NY

Practice address

10 Canalview Mall
Suite C
Fulton, NY 13069-1769

Phone

(315) 593-8786

Fax

(315) 598-5538

NPI assigned

Apr 23, 2009

Last updated

Apr 23, 2009By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Primary Physical Therapy PLLC

  dba PROActive Physical therapy

  • Physical Therapist
  • North Syracuse, NY
  • NPI 1922071257
  NPD (past)

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240444800000",
    "number": "1316181217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CANALVIEW MALL",
            "address_2": "SUITE C",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691769",
            "telephone_number": "315-593-8786",
            "fax_number": "315-598-5538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CANALVIEW MALL",
            "address_2": "SUITE C",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691769",
            "telephone_number": "315-593-8786",
            "fax_number": "315-598-5538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEFFREY",
        "middle_name": "DAVID",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-23",
        "last_updated": "2009-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "0086361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11956359",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jean E. Wilcox, L.P.N.
• Elizabeth Regina Wilkins, L.P.N.
• Williampoole
• Helen Williams, PA
• Patricia E. Williams, R.D.
• Justine Witkovsky, REGISTERED NURSE
• Michelle Louise Yablonski, RN
• Cynthia J Young-Mayka, P.A.
• Taylor Elizabeth Young, PA
• Amanda M Yousey

• Physical Therapist in Fulton, NY
• Providers in Fulton, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; 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.