Active NPI
Ellen B Wilson, P.T.
- Physical Therapist
- Collins, NY
National Provider Identifier
1487615522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 008212-1
- Practice address
- 14318 Route 62
Collins, NY 14034-9788 - Phone
- (716) 532-8129
- Fax
- (716) 532-9201
- NPI assigned
- Mar 29, 2006
- Sex
- Female
- 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 Therapist | 225100000X | 008212-1 | NY | Primary |
Addresses
Primary practice location
14318 Route 62
Collins, NY 14034-9788
Mailing address
3311 Brown St
Collins, NY 14034-9779
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10489845 | Other | NY | CAQH |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008212-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209600000000",
"number": "1487615522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3311 BROWN ST",
"city": "COLLINS",
"state": "NY",
"postal_code": "140349779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14318 ROUTE 62",
"city": "COLLINS",
"state": "NY",
"postal_code": "140349788",
"telephone_number": "716-532-8129",
"fax_number": "716-532-9201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ELLEN",
"middle_name": "B",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-29",
"last_updated": "2008-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "008212-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10489845",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Collins, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.