Richard Max Wilson, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05003667A Issued in IN

Practice address

310 Duran Dr
Shelbyville, IN 46176-1986

Phone

(317) 421-0244

Fax

(317) 421-0245

NPI assigned

Apr 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470096000000",
    "number": "1407818651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 DURAN DR",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461761986",
            "telephone_number": "317-421-0244",
            "fax_number": "317-421-0245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RICHARD",
        "middle_name": "MAX",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2016-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05003667A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200146190",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ID",
            "identifier": "000000112015",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin Willfond, MD - MPH
• Destiny Williams
• Kristin L. Willis, PA-C
• Lindsay Elizabeth Wilmer
• Colleen Wilson, RBT
• Kyle Witkemper, ATC.,LAT
• Brittany Mischelle Wood
• X-Ray Physicians of Shelbyville PC
• Corinne Young, PSYD, HSPP
• Ariel Elizabeth Zalesin, DDS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.