Active NPI
Douglas James Willette, PTA
- Physical Therapy Assistant
- Dallas, TX
National Provider Identifier
1427178409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 86001508A
- Practice address
- 325 N Saint Paul St
Suite 4200
Dallas, TX 75201-3801 - Phone
- (866) 953-0011
- Fax
- (866) 953-0012
- NPI assigned
- Mar 31, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 86001508A | IN | Primary |
Addresses
Primary practice location
325 N Saint Paul St
Suite 4200
Dallas, TX 75201-3801
Mailing address
3510 Lowden St
Kalamazoo, MI 49008-2638
Phone (269) 385-5999
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 |
|---|---|---|---|
| 86001508A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427178409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3510 LOWDEN ST",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490082638",
"telephone_number": "269-385-5999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 N SAINT PAUL ST",
"address_2": "SUITE 4200",
"city": "DALLAS",
"state": "TX",
"postal_code": "752013801",
"telephone_number": "866-953-0011",
"fax_number": "866-953-0012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLETTE",
"first_name": "DOUGLAS",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "86001508A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.