Western Trails Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2684 Issued in NE

Legal business name

WESTERN TRAILS PHYSICAL THERAPY, LLC

Practice address

1463 19TH Ave
Suite B
Mitchell, NE 69357-1455

Phone

(308) 623-1313

Fax

(308) 623-1315

NPI assigned

Mar 31, 2011

Last updated

Mar 31, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Wesly Bowlin, D.P.T.NPI 1063719144

Title

Owner/Manager/President

Phone

(308) 623-1313

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Wesly Bowlin, DPT

  • Physical Therapist
  • Mitchell, NE
  • NPI 1063719144
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301529600000",
    "number": "1700175619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1463 19TH AVE",
            "address_2": "SUITE B",
            "city": "MITCHELL",
            "state": "NE",
            "postal_code": "693571455",
            "telephone_number": "308-623-1313",
            "fax_number": "308-623-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1463 19TH AVE",
            "address_2": "SUITE B",
            "city": "MITCHELL",
            "state": "NE",
            "postal_code": "693571455",
            "telephone_number": "308-623-1313",
            "fax_number": "308-623-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN TRAILS PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-31",
        "last_updated": "2011-03-31",
        "status": "A",
        "authorized_official_last_name": "BOWLIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WESLY",
        "authorized_official_title_or_position": "OWNER/MANAGER/PRESIDENT",
        "authorized_official_telephone_number": "308-623-1313",
        "authorized_official_credential": "D.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NE",
            "license": "2684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Splichal, MS, CCC-SLP
• Gabriella Lyn Stevenson
• Susan B Weitzel
• Western Trails Chiropractic LLC
• Western Trails Family Medicine, LLC

• Physical Therapist in Mitchell, NE
• Providers in Mitchell, NE by specialty
• Physical Therapist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.