Active NPI
Emmanuel Requena Sr.
- Physical Therapist
- Wabash, IN
National Provider Identifier
1861893745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 06004053A
- Practice address
- 20 John Kissinger Dr
Wabash, IN 46992-1648 - Phone
- (260) 274-0868
- NPI assigned
- Sep 10, 2014
- 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 | 06004053A | IN | Primary |
Addresses
Primary practice location
20 John Kissinger Dr
Wabash, IN 46992-1648
Mailing address
9219 Barbara LN
Fort Wayne, IN 46804-4702
Phone (260) 579-1748
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 |
|---|---|---|---|
| 06004053A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410307200000",
"number": "1861893745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9219 BARBARA LN",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044702",
"telephone_number": "260-579-1748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 JOHN KISSINGER DR",
"city": "WABASH",
"state": "IN",
"postal_code": "469921648",
"telephone_number": "260-274-0868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REQUENA",
"first_name": "EMMANUEL",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-10",
"last_updated": "2014-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "06004053A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wabash, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.