Active NPI
Jonathan B Wilson, DPT
- Physical Therapist
- Mannington, WV
National Provider Identifier
1760791552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 002873
- Practice address
- 802 East Main St
Mannington, WV 26582 - Phone
- (304) 986-9007
- Fax
- (304) 986-9007
- NPI assigned
- Sep 28, 2010
- Sex
- Male
- 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 Therapist | 225100000X | 002873 | WV | Primary |
Addresses
Primary practice location
802 East Main St
Mannington, WV 26582
Mailing address
719 Fairmont Avenue
Suite 102
Fairmont, WV 26554
Phone (304) 363-8543
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 |
|---|---|---|---|
| 002873 | WV | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain State Physical Therapy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Mountain State Physical Therapy
- Physical Therapy Clinic/Center
- Fairmont, WV
- NPI 1083668875
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285632000000",
"number": "1760791552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "719 FAIRMONT AVENUE",
"address_2": "SUITE 102",
"city": "FAIRMONT",
"state": "WV",
"postal_code": "26554",
"telephone_number": "304-363-8543",
"fax_number": "304-363-0173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 EAST MAIN ST",
"city": "MANNINGTON",
"state": "WV",
"postal_code": "26582",
"telephone_number": "304-986-9007",
"fax_number": "304-986-9007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JONATHAN",
"middle_name": "B",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-28",
"last_updated": "2010-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "002873",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mannington, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.