Individual provider Active NPI

Wanda Bell, PT

  • Specialist
  • Longview, TX
National Provider Identifier
1710007133
Registry record updated Jul 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
1110948 Issued in TX
Practice address
5907 W. Marshall Ave
Longview, TX 75604
Phone
(903) 759-6500
Fax
(903) 759-6500
NPI assigned
Mar 30, 2007
Last updated
Jul 10, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 1110948 TX Primary

Addresses

Primary practice location

5907 W. Marshall Ave
Longview, TX 75604

Mailing address

5907 W. Marshall Ave
Longview, TX 75604
Phone (903) 759-6500

Other identifiers 2

IdentifierTypeStateIssuer
0631053-03MedicaidTX
063105302MedicaidTX

Other names 1

  • Ms. Wanda Rodriguez Former name

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

LicenseStateTypeSpecialty
1110948TXMDSpecialist

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278720000000",
    "number": "1710007133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5907 W. MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75604",
            "telephone_number": "903-759-6500",
            "fax_number": "903-759-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5907 W. MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75604",
            "telephone_number": "903-759-6500",
            "fax_number": "903-759-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELL",
        "first_name": "WANDA",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2010-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "1110948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0631053-03",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063105302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WANDA",
            "last_name": "RODRIGUEZ",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.