Active NPI
Samantha Wambles Wise, LPTA
- Physical Therapy Assistant
- Louisville, KY
National Provider Identifier
1457698870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA5120
- Practice address
- 303 N Hurstbourne Pkwy Ste 200
Louisville, KY 40222-5158 - Phone
- (502) 412-5847
- NPI assigned
- Jan 4, 2013
- 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 | PTA5120 | AL | Primary |
Addresses
Primary practice location
303 N Hurstbourne Pkwy Ste 200
Louisville, KY 40222-5158
Mailing address
765 Hickman Ave E
Kinston, AL 36453-3414
Phone (334) 897-8265
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 |
|---|---|---|---|
| PTA5120 | AL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357257600000",
"number": "1457698870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "765 HICKMAN AVE E",
"city": "KINSTON",
"state": "AL",
"postal_code": "364533414",
"telephone_number": "334-897-8265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 N HURSTBOURNE PKWY STE 200",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402225158",
"telephone_number": "502-412-5847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "SAMANTHA",
"middle_name": "WAMBLES",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-04",
"last_updated": "2013-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AL",
"license": "PTA5120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.