Active NPI
Matthew David Wilson, RADT
- Rehabilitation Practitioner
- Van Nuys, CA
National Provider Identifier
1326867136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- R1462230322
- Practice address
- 14515 Hamlin St Ste 100
Van Nuys, CA 91411-1694 - Phone
- (206) 902-0769
- NPI assigned
- Oct 8, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | R1462230322 | CA | Primary |
Addresses
Primary practice location
14515 Hamlin St Ste 100
Van Nuys, CA 91411-1694
Mailing address
PO Box 1554
Venice, CA 90294-1554
Phone (206) 902-0769
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 |
|---|---|---|---|
| R1462230322 | CA | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728345600000",
"number": "1326867136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1554",
"city": "VENICE",
"state": "CA",
"postal_code": "902941554",
"telephone_number": "206-902-0769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14515 HAMLIN ST STE 100",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914111694",
"telephone_number": "206-902-0769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MATTHEW",
"middle_name": "DAVID",
"credential": "RADT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-10-08",
"last_updated": "2024-10-08",
"certification_date": "2024-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "R1462230322",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Nuys, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.