Active NPI
Natalie M Wilson, PT
- Physical Therapist
- Portage, IN
National Provider Identifier
1679719850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05007071A
- Practice address
- 3691 Willowcreek Rd
Portage, IN 46368-5076 - Phone
- (219) 759-4380
- NPI assigned
- Dec 18, 2008
- 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 Therapist | 225100000X | 05007071A | IN | Primary |
Addresses
Primary practice location
3691 Willowcreek Rd
Portage, IN 46368-5076
Mailing address
106 Glendale Blvd
Valparaiso, IN 46383-3032
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 |
|---|---|---|---|
| 05007071A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229558400000",
"number": "1679719850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 GLENDALE BLVD",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463833032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3691 WILLOWCREEK RD",
"city": "PORTAGE",
"state": "IN",
"postal_code": "463685076",
"telephone_number": "219-759-4380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "NATALIE",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-18",
"last_updated": "2008-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05007071A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.