Thad Justin Willis, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-1633 Issued in WY

Practice address

2002 W Sunset Dr
Suite 1
Riverton, WY 82501-2283

Phone

(307) 856-7021

Fax

(307) 856-5546

NPI assigned

Jun 10, 2016

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 names 1

• Justin Willis Other name

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fremont Therapy Group Limited PartnershipGroup PAC ID 4284042649, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fremont Therapy Group Limited Partnership

  • Physical Therapist
  • Riverton, WY
  • NPI 1487244042
  Medicare reassignment Care Compare group NPD
• Fremont Therapy Group LLC

  • Physical Therapist
  • Riverton, WY
  • NPI 1477568046
  Medicare reassignment NPD
• Fremont Therapy Group Limited Partnership

  • Durable Medical Equipment & Medical Supplies
  • Green River, WY
  • NPI 1649165317
  NPD

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

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465516800000",
    "number": "1467801340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 W SUNSET DR",
            "address_2": "SUITE 1",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825012283",
            "telephone_number": "307-856-7021",
            "fax_number": "307-856-5546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 W SUNSET DR",
            "address_2": "SUITE 1",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825012283",
            "telephone_number": "307-856-7021",
            "fax_number": "307-856-5546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "THAD",
        "middle_name": "JUSTIN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-10",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WY",
            "license": "PT-1633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUSTIN",
            "last_name": "WILLIS",
            "credential": "DPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ashten K Whiteplume
• Ryan J Wilcox, CRNA
• Wildflower Wellness Counseling LLC
• Dennis E Williams, MSW, ACSW
• Jeffery Alan Williams
• Marie Clair Willow, CPS
• Shaylyn Nicole Willow, CSW
• Charles Emmons Wilson, MA LMFT
• William Carrel Wilson, DVM
• Wind River Cares Riverton

• Physical Therapist in Riverton, WY
• Providers in Riverton, WY by specialty
• Physical Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.