Active NPI
Mariah Wilson, PT, DPT
- Physical Therapist
- Fair Oaks, CA
National Provider Identifier
1720563885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT40400
- Practice address
- 8530 Willings Way
Fair Oaks, CA 95628-6235 - Phone
- (760) 419-4053
- NPI assigned
- Sep 25, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | PT40400 | CA | Primary |
Addresses
Primary practice location
8530 Willings Way
Fair Oaks, CA 95628-6235
Mailing address
8530 Willings Way
Fair Oaks, CA 95628-6235
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT40400 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537833600000",
"number": "1720563885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8530 WILLINGS WAY",
"city": "FAIR OAKS",
"state": "CA",
"postal_code": "956286235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8530 WILLINGS WAY",
"city": "FAIR OAKS",
"state": "CA",
"postal_code": "956286235",
"telephone_number": "760-419-4053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MARIAH",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-25",
"last_updated": "2018-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT40400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fair Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.