Active NPI
Billy Wayne Vandyke, PTA
- Physical Therapy Assistant
- Williamson, WV
National Provider Identifier
1659382786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 000652
- Practice address
- 54 W 3Rd Ave
Williamson, WV 25661-3508 - Phone
- (304) 235-4300
- Fax
- (304) 235-0176
- NPI assigned
- Aug 11, 2006
- 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 | 000652 | WV | Primary |
Addresses
Primary practice location
54 W 3Rd Ave
Williamson, WV 25661-3508
Mailing address
515 Dickenson St Apt 1
Williamson, WV 25661-3257
Phone (304) 235-4300
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 |
|---|---|---|---|
| 000652 | WV | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physcial and Aquatic Therapy, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Williamson, WV
- NPI 1578671681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1659382786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 DICKENSON ST APT 1",
"city": "WILLIAMSON",
"state": "WV",
"postal_code": "256613257",
"telephone_number": "304-235-4300",
"fax_number": "304-235-0176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54 W 3RD AVE",
"city": "WILLIAMSON",
"state": "WV",
"postal_code": "256613508",
"telephone_number": "304-235-4300",
"fax_number": "304-235-0176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDYKE",
"first_name": "BILLY",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WV",
"license": "000652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamson, WV
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.