Active NPI
Wallace Wilson, MSPT
- Physical Therapist
- Anchorage, AK
National Provider Identifier
1730423666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1625
- Practice address
- 701 Sesame St
Suite 101
Anchorage, AK 99503-6647 - Phone
- (907) 561-2260
- NPI assigned
- Nov 15, 2012
- Sex
- Male
- 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 | 1625 | AK | Primary |
Addresses
Primary practice location
701 Sesame St
Suite 101
Anchorage, AK 99503-6647
Mailing address
701 Sesame St
Suite 101
Anchorage, AK 99503-6647
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1625 | AK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Human Performance and Rehabilitation Centers, Inc. | Physical Therapist | Past | Accepting new patients |
| Human Performance and Rehabilitation Centers, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Medical and Health Resources
- Orthotist
- Columbus, GA
- NPI 1437223666
-
dba HPRC, Inc.
- Physical Therapist
- Columbus, GA
- NPI 1609813989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1352937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352937600000",
"number": "1730423666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 SESAME ST",
"address_2": "SUITE 101",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995036647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 SESAME ST",
"address_2": "SUITE 101",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995036647",
"telephone_number": "907-561-2260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "WALLACE",
"credential": "MSPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-15",
"last_updated": "2012-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AK",
"license": "1625",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.