Active NPI
Tracy Lynn Wilson, MS
- Rehabilitation Practitioner
- Covina, CA
National Provider Identifier
1699892612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 1211 Center Court Dr Ste 105
Covina, CA 91724-3672 - Phone
- (626) 859-2089
- Fax
- (626) 859-6537
- NPI assigned
- Mar 23, 2007
- 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
1211 Center Court Dr Ste 105
Covina, CA 91724-3672
Mailing address
16502 Casa Grande Ave Unit 619
Fontana, CA 92336-6114
Phone (626) 859-2089
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780617600000",
"number": "1699892612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16502 CASA GRANDE AVE UNIT 619",
"city": "FONTANA",
"state": "CA",
"postal_code": "923366114",
"telephone_number": "626-859-2089",
"fax_number": "626-859-6537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1211 CENTER COURT DR STE 105",
"city": "COVINA",
"state": "CA",
"postal_code": "917243672",
"telephone_number": "626-859-2089",
"fax_number": "626-859-6537"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "TRACY",
"middle_name": "LYNN",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-23",
"last_updated": "2026-06-05",
"certification_date": "2026-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.