Active NPI
John Waszak
- Physical Therapist
- Fort Leonard Wood, MO
National Provider Identifier
1770031056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13538-29
- Practice address
- 4430 Missouri Avenue
Box Number 1267
Fort Leonard Wood, MO 65473-2603 - Phone
- (624) 089-3572
- NPI assigned
- Sep 15, 2016
- 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 | 13538-29 | WI | Primary |
Addresses
Primary practice location
4430 Missouri Avenue
Box Number 1267
Fort Leonard Wood, MO 65473-2603
Mailing address
154 Mesa Dr.
Waynesville, MO 65583
Phone (262) 408-9357
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13538-29 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682380800000",
"number": "1770031056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "154 MESA DR.",
"city": "WAYNESVILLE",
"state": "MO",
"postal_code": "65583",
"telephone_number": "262-408-9357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4430 MISSOURI AVENUE",
"address_2": "BOX NUMBER 1267",
"city": "FORT LEONARD WOOD",
"state": "MO",
"postal_code": "654732603",
"telephone_number": "624-089-3572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASZAK",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-15",
"last_updated": "2023-04-25",
"certification_date": "2023-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "13538-29",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Leonard Wood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.