Nathan Drew Wibisono, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1377813 Issued in TX

Practice address

4701 W Parker Rd # 625
Plano, TX 75093-3376

Phone

(972) 398-2555

NPI assigned

Jun 13, 2023

Last updated

Jun 13, 2023By the provider in NPPES

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

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": "1686614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1922782606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 CHESTNUT LN",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750192113",
            "telephone_number": "469-556-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 W PARKER RD # 625",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750933376",
            "telephone_number": "972-398-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIBISONO",
        "first_name": "NATHAN",
        "middle_name": "DREW",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-13",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1377813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kali Van Buskirk Whitney, PA-C
• Megan Lattier Whittemore, PA-C
• Quanisha Yvonnecris Whittfield
• Whole Body Chiropractic LLC
• Eunhee Wi, PMHNP
• Christa Marie Widjaja, OD
• Jacqueline Babbs Wiebe, PH.D
• James N Wiebe, M.S., LMFT-A
• Sheryl Lynn Wiedermann, AU.D, CCC-A
• Todd Mitchell Wien, MD

• Physical Therapist in Plano, TX
• Providers in Plano, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.