Indiana Wesleyan University

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

INDIANA WESLEYAN UNIVERSITY

Doing business as

The Center for Sports & Physical Therapy

Practice address

1310 Manchester Ave
Wabash, IN 46992-1615

Phone

(260) 563-5630

NPI assigned

May 4, 2026

Last updated

May 7, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

INDIANA WESLEYAN UNIVERSITYAs reported in NPPES

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

Authorized official

Name

Jeff Rayis

Title

Cfo

Phone

(765) 677-6573

Specialties & licenses 2

Addresses

Other names 1

• The Center for Sports & Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Indiana Wesleyan University

  dba The Center for Sports & Physical Therapy

  • Physical Therapist
  • Marion, IN
  • NPI 1154258366

  O20260616003123

  Same enrollment

Tax ID family

Indiana Wesleyan University3 organizations share this tax ID, including this one

Part of

Indiana Wesleyan University

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Indiana Wesleyan University

  dba The Center for Sports & Physical Therapy

  • Physical Therapist
  • Marion, IN
  • NPI 1154258366
  NPD tax ID
• Indiana Wesleyan University

  dba Wildcat Clinic

  • Student Health Clinic/Center
  • Marion, IN
  • NPI 1558491894
  NPD tax ID

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brandon Lee Bussa, DPT

  • Physical Therapist
  • Marion, IN
  • NPI 1932714276
  NPD (past)
• Marc Andrew Holderead, OTR

  • Occupational Therapist
  • Marion, IN
  • NPI 1154713493
  NPD (past)
• Keith William Lancaster, DPT

  • Physical Therapist
  • Wabash, IN
  • NPI 1447377304
  NPD (past)
• Matthew David Lavin, PT, DPT, LSVT

  • Physical Therapist
  • Marion, IN
  • NPI 1609792019
  NPD (past)
• Cassidy Reust

  • Occupational Therapist
  • Marion, IN
  • NPI 1568354892
  NPD (past)
• Lee Martin Smith, MS,PT

  • Physical Therapist
  • Marion, IN
  • NPI 1730206681
  NPD (past)
• Rachel Vogler, OTD, OTR

  • Occupational Therapist
  • Marion, IN
  • NPI 1629757950
  NPD (past)

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

{
    "created_epoch": "1777852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778112000000",
    "number": "1316874522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 S ADAMS ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469535349",
            "telephone_number": "765-674-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 MANCHESTER AVE",
            "city": "WABASH",
            "state": "IN",
            "postal_code": "469921615",
            "telephone_number": "260-563-5630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA WESLEYAN UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIANA WESLEYAN UNIVERSITY",
        "enumeration_date": "2026-05-04",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A",
        "authorized_official_last_name": "RAYIS",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "765-677-6573"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Center for Sports & Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carolyn J Hunt, MSW,ACSW,LCSW
• Andrea Marie Hutton, D.D.S.
• Staci R Hyden, MA, LCSW, CADAC II
• Jay Sanvictores Icasiano
• Indiana Oncology Hematology Consultants
• Alberto Jaime
• James E. Haughn (Wabash Medical Center)
• Jeffrey W Miller DO PC
• Johnson Memorial Hospital (The Waters of Wabash Skilled Nursing Facility West)
• Johnson Memorial Hospital (The Waters of Wabash Skilled Nursing Facility East)

• Physical Therapist in Wabash, IN
• Providers in Wabash, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.