Active NPI
Tyreesah Lashae Wilkerson-Cobb
- Prosthetic/Orthotic Supplier
- Philadelphia, PA
National Provider Identifier
1750098760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- 807950
- Practice address
- 5613 Master St
Philadelphia, PA 19131-3833 - Phone
- (215) 820-8073
- NPI assigned
- Oct 31, 2022
- 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 |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | 807950 | PA | Primary |
Addresses
Primary practice location
5613 Master St
Philadelphia, PA 19131-3833
Mailing address
5613 Master St
Philadelphia, PA 19131-3833
Phone (215) 820-8073
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 |
|---|---|---|---|
| 807950 | PA | MD | Prosthetic/Orthotic Supplier |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667174400000",
"number": "1750098760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5613 MASTER ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191313833",
"telephone_number": "215-820-8073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5613 MASTER ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191313833",
"telephone_number": "215-820-8073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKERSON-COBB",
"first_name": "TYREESAH",
"middle_name": "LASHAE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-31",
"last_updated": "2022-10-31",
"certification_date": "2022-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "PA",
"license": "807950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.