Marita Illescas, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05013849A Issued in IN

Practice address

235 E High St
Mooresville, IN 46158-1639

Phone

(317) 371-8180

Fax

(833) 925-2447

NPI assigned

Sep 12, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Marita Miller Former name

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25627/brand/1/csg/1/fhir/r4

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.

• Wound Therapy, LLC

  • Physical Therapy Clinic/Center
  • Mooresville, IN
  • NPI 1033887369

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1336975655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 E HIGH ST",
            "city": "MOORESVILLE",
            "state": "IN",
            "postal_code": "461581639",
            "telephone_number": "317-371-8180",
            "fax_number": "833-925-2447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 E HIGH ST",
            "city": "MOORESVILLE",
            "state": "IN",
            "postal_code": "461581639",
            "telephone_number": "317-371-8180",
            "fax_number": "833-925-2447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLESCAS",
        "first_name": "MARITA",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05013849A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARITA",
            "last_name": "MILLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Charles J Howard, LMHC
• Briana L Huber
• Melanie Huene, PHD, HSPP
• Kimberly Lynn Huffman, FNP-C
• Terri Joann Hughes, HIS
• Gregg A Imel, MD
• Indiana Heart Physicians, Inc.
• Indiana University Eye Care, Inc.
• Jennifer Ingram, LCSW
• Neal Edward Ipema, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; 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.