Active NPI
Anthony Wayne Walin, PTA
- Physical Therapy Assistant
- Medford, OR
National Provider Identifier
1760145312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 9881
- Practice address
- 2901 E Barnett Rd
Medford, OR 97504-8308 - Phone
- (541) 779-4221
- NPI assigned
- Oct 20, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Respiratory/Developmental/Rehabilitative Specialist/Technologist | 225500000X | 9881 | OR | |
| Physical Therapy Assistant | 225200000X | 9881 | OR | Primary |
Addresses
Primary practice location
2901 E Barnett Rd
Medford, OR 97504-8308
Mailing address
2895 N Myrtle Rd
Myrtle Creek, OR 97457-9660
Phone (619) 300-5361
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 |
|---|---|---|---|
| 9881 | OR | MD | Respiratory/Developmental/Rehabilitative Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635120000000",
"number": "1760145312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2895 N MYRTLE RD",
"city": "MYRTLE CREEK",
"state": "OR",
"postal_code": "974579660",
"telephone_number": "619-300-5361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 E BARNETT RD",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975048308",
"telephone_number": "541-779-4221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALIN",
"first_name": "ANTHONY",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-10-20",
"last_updated": "2021-10-25",
"certification_date": "2021-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "225500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist",
"state": "OR",
"license": "9881",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "OR",
"license": "9881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.