Matthew Wilson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT291158 Issued in CA

Practice address

82013 Dr Carreon Blvd
Ste I
Indio, CA 92201-4832

Phone

(760) 347-6195

Fax

(760) 347-2849

NPI assigned

Feb 25, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MDRS Spine and Sport IncGroup PAC ID 3274446687, 181 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MDRS Spine & Sport, Inc

  • Multi-Specialty Clinic/Center
  • San Diego, CA
  • NPI 1952394603

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• MDRS Spine & Sport, Inc

  • Physical Therapist
  • Temecula, CA
  • NPI 1689824203
  NPD

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

{
    "created_epoch": "1456358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456358400000",
    "number": "1790145217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 WALNUT ST",
            "address_2": "SUITE 110",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012416",
            "telephone_number": "805-788-0805",
            "fax_number": "805-788-0845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82013 DR CARREON BLVD",
            "address_2": "STE I",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922014832",
            "telephone_number": "760-347-6195",
            "fax_number": "760-347-2849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MATTHEW",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-25",
        "last_updated": "2016-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT291158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonard Adam Williamson, RADT
• Michael R Williamson, RN
• Bryan Wilmoth, CATC-III
• Candice Wilson
• Errol Wilson, FNP
• Steven Karl Wilson, MD
• Jade Windsor, B.S
• Gerald Winn
• Joshua Winn, MD
• Lisa A Wolfe

• Physical Therapist in Indio, CA
• Providers in Indio, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.