Annetta Wilson, P.T.

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT-00000493 Issued in ID

Practice address

640 N Eisenhower St
Moscow, ID 83843-9588

Phone

(208) 882-6560

Fax

(208) 882-6569

NPI assigned

Jan 5, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1262649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262649600000",
    "number": "1891025482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 N EISENHOWER ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838439588",
            "telephone_number": "208-882-6560",
            "fax_number": "208-882-6569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 N EISENHOWER ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838439588",
            "telephone_number": "208-882-6560",
            "fax_number": "208-882-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANNETTA",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-05",
        "last_updated": "2010-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "PT-80",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "PT-00000493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Elizabeth Wildman, RDN, RD
• Dayna K. Willbanks, OTR/L
• Madison Willhide
• Jacqueline M Williams, MS, LAT, ATC
• Wilson Polito PLLC
• Kylie Elizabeth Wilson
• Michelle P Winter
• Lila M Witter, LMT
• Gloria Workman, NP
• Mark Francis Yama, PH.D.

• Specialist in Moscow, ID
• Providers in Moscow, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.