Active NPI
Sean Alan Wilson, P.T.
- Physical Therapist
- Tyndall Afb, FL
National Provider Identifier
1639336357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11624
- Practice address
- 325 MDG
340 Magnolia Circle
Tyndall Afb, FL 32403-5604 - Phone
- (336) 598-2472
- NPI assigned
- May 20, 2008
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11264 | NC | |
| Physical Therapist | 225100000X | 11624 | NC | Primary |
Addresses
Primary practice location
325 MDG
340 Magnolia Circle
Tyndall Afb, FL 32403-5604
Mailing address
325 MDG
340 Magnolia Circle
Tyndall Afb, FL 32403-5604
Phone (336) 598-2472
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 |
|---|---|---|---|
| 11264 | NC | MD | Emergency Medicine Physician |
| 11624 | NC | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584057600000",
"number": "1639336357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 MDG",
"address_2": "340 MAGNOLIA CIRCLE",
"city": "TYNDALL AFB",
"state": "FL",
"postal_code": "324035604",
"telephone_number": "336-598-2472"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 MDG",
"address_2": "340 MAGNOLIA CIRCLE",
"city": "TYNDALL AFB",
"state": "FL",
"postal_code": "324035604",
"telephone_number": "336-598-2472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SEAN",
"middle_name": "ALAN",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-20",
"last_updated": "2020-03-13",
"certification_date": "2020-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "NC",
"license": "11264",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "11624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyndall Afb, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.