Active NPI
Andrea Wainright, PTA
- Physical Therapy Assistant
- Peoria, IL
National Provider Identifier
1730780842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 0003586
- Practice address
- 3535 N Rochelle LN
Peoria, IL 61604-1036 - Phone
- (309) 685-8800
- NPI assigned
- Nov 4, 2020
- Sex
- Female
- Sole proprietor
- No
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 Therapy Assistant | 225200000X | 0003586 | IL | Primary |
Addresses
Primary practice location
3535 N Rochelle LN
Peoria, IL 61604-1036
Mailing address
816 S Johanson Rd
Peoria, IL 61607-1088
Phone (309) 696-5911
Other practice location 1
6901 N Galena Rd
Peoria, IL 61614-3193
Phone (309) 689-2383
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 |
|---|---|---|---|
| 0003586 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604707200000",
"number": "1730780842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "816 S JOHANSON RD",
"city": "PEORIA",
"state": "IL",
"postal_code": "616071088",
"telephone_number": "309-696-5911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 N ROCHELLE LN",
"city": "PEORIA",
"state": "IL",
"postal_code": "616041036",
"telephone_number": "309-685-8800"
}
],
"practiceLocations": [
{
"address_1": "6901 N Galena Rd",
"address_purpose": "LOCATION",
"city": "Peoria",
"state": "IL",
"postal_code": "616143193",
"country_code": "US",
"telephone_number": "309-689-2383",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WAINRIGHT",
"first_name": "ANDREA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-04",
"last_updated": "2020-11-07",
"certification_date": "2020-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "0003586",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.