Active NPI
Chad J Wilson, PT
- Physical Therapist
- Indianapolis, IN
National Provider Identifier
1861575557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05008759A
- Practice address
- 7035 W 96TH Street # D
Indianapolis, IN 76250-3303 - Phone
- (317) 284-0505
- Fax
- (317) 284-0507
- NPI assigned
- Oct 24, 2006
- 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 | 05008759A | IN | Primary |
Addresses
Primary practice location
7035 W 96TH Street # D
Indianapolis, IN 76250-3303
Mailing address
7759 E Washington St
Indianapolis, IN 46219-6742
Phone (317) 359-1215
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000384246 | Other | IN | ANTHEM |
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 |
|---|---|---|---|
| 05008759A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861575557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7759 E WASHINGTON ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462196742",
"telephone_number": "317-359-1215",
"fax_number": "317-359-1235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7035 W 96TH STREET # D",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "762503303",
"telephone_number": "317-284-0505",
"fax_number": "317-284-0507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CHAD",
"middle_name": "J",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05008759A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000384246",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.