Angela Wilson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502004551 Issued in MI

Practice address

16000 Southfield Rd
Allen Park, MI 48101-2563

Phone

(313) 359-8867

Fax

(313) 359-8868

NPI assigned

Jul 30, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Angela Jean Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1730852278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-350-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16000 SOUTHFIELD RD",
            "city": "ALLEN PARK",
            "state": "MI",
            "postal_code": "481012563",
            "telephone_number": "313-359-8867",
            "fax_number": "313-359-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANGELA",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-30",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502004551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "JEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sheryl West
• Western Wayne Family Physicians, PLC
• Shelby Lynn Wilkie
• Willowsage Counseling
• Wilson Therapeutic Solutions LLC
• Yvonne Wilson, LPC
• Woodward Detroit CVS LLC
• Woodward Detroit CVS, L.L.C.
• Wyandotte Physician Practices
• Samantha Victoria Wydryck

• Physical Therapy Assistant in Allen Park, MI
• Providers in Allen Park, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.