Active NPI
Blaire Evans Wilkie
- Physical Therapist
- Rockaway, NJ
National Provider Identifier
1366079261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA01808400
- Practice address
- 333 Mount Hope Ave Ste 310
Rockaway, NJ 07866-1657 - Phone
- (973) 683-2360
- NPI assigned
- Mar 23, 2020
- Sex
- Female
- 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 | 40QA01808400 | NJ | Primary |
Addresses
Primary practice location
333 Mount Hope Ave Ste 310
Rockaway, NJ 07866-1657
Mailing address
333 Mount Hope Ave Ste 310
Rockaway, NJ 07866-1657
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 |
|---|---|---|---|
| 40QA01808400 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584921600000",
"number": "1366079261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 MOUNT HOPE AVE STE 310",
"city": "ROCKAWAY",
"state": "NJ",
"postal_code": "078661657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 MOUNT HOPE AVE STE 310",
"city": "ROCKAWAY",
"state": "NJ",
"postal_code": "078661657",
"telephone_number": "973-683-2360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKIE",
"first_name": "BLAIRE",
"middle_name": "EVANS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-23",
"last_updated": "2020-03-23",
"certification_date": "2020-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA01808400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockaway, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.