Carl S Wiltbank, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8544 Issued in AZ

Practice address

80 S 13TH West
St. Johns, AZ 85936

Phone

(928) 337-3020

Fax

(928) 337-3979

NPI assigned

Jun 29, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Black Ridge Physical Therapy, PLC

  • Physical Therapy Clinic/Center
  • Saint Johns, AZ
  • NPI 1649698945
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405036800000",
    "number": "1699903757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 824",
            "city": "SAINT JOHNS",
            "state": "AZ",
            "postal_code": "859360824",
            "telephone_number": "928-337-3020",
            "fax_number": "928-337-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 S 13TH WEST",
            "city": "ST. JOHNS",
            "state": "AZ",
            "postal_code": "85936",
            "telephone_number": "928-337-3020",
            "fax_number": "928-337-3979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILTBANK",
        "first_name": "CARL",
        "middle_name": "S",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2014-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "8544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "443777",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Donovan Tenney, D.D.S.
• Sandra Maureen Thompson, LPC
• Western Drug Inc
• White Mountain Regional Medical Center Rural Health Clinic - St. Johns
• Tifani Kaye Wilhelm

• Physical Therapist in St. Johns, AZ
• Providers in St. Johns, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.