Justine Breanne Wilson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60957709 Issued in WA

Practice address

11811 N Tatum Blvd Ste 3031
Phoenix, AZ 85028-1621

Phone

(602) 708-8091

Fax

(602) 218-6462

NPI assigned

Dec 2, 2019

Sex

Female

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 AZ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Wheels on the Bus, Inc.

  • Home Health Agency
  • Phoenix, AZ
  • NPI 1740353127

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1871130583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11811 N TATUM BLVD STE 3031",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850281621",
            "telephone_number": "602-708-8091",
            "fax_number": "602-218-6462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11811 N TATUM BLVD STE 3031",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850281621",
            "telephone_number": "602-708-8091",
            "fax_number": "602-218-6462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JUSTINE",
        "middle_name": "BREANNE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-02",
        "last_updated": "2023-08-02",
        "certification_date": "2023-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60957709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane N Wilson, CNM
• Jazmine Marie Wilson, RDH
• Jeremy Wilson
• Jessica Wilson
• Julie L Wilson, MFT
• Kathryn Wilson, PA-C
• Kathryn Wilson, FNP-C
• Kimberly M Wilson, NMD,LPC,LMFT, LCDC,L
• Kira Wilson
• Kristy Wilson, RN

• Physical Therapist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.