Active NPI
Marissa Louise Wilson, PTA
- Physical Therapy Assistant
- Birmingham, AL
National Provider Identifier
1386029064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA7640
- Practice address
- 1717 6TH Avenue South
Room 385 3Rd Floor
Birmingham, AL 35294 - Phone
- (205) 975-4922
- NPI assigned
- Jul 23, 2015
- 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 Therapy Assistant | 225200000X | PTA7640 | AL | Primary |
Addresses
Primary practice location
1717 6TH Avenue South
Room 385 3Rd Floor
Birmingham, AL 35294
Mailing address
1717 6TH Avenue South
Room 385 3Rd Floor
Birmingham, AL 35294
Phone (205) 975-4922
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 |
|---|---|---|---|
| PTA7640 | AL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437609600000",
"number": "1386029064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 6TH AVENUE SOUTH",
"address_2": "ROOM 385 3RD FLOOR",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "35294",
"telephone_number": "205-975-4922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 6TH AVENUE SOUTH",
"address_2": "ROOM 385 3RD FLOOR",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "35294",
"telephone_number": "205-975-4922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MARISSA",
"middle_name": "LOUISE",
"name_prefix": "Ms.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-07-23",
"last_updated": "2015-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AL",
"license": "PTA7640",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.