Individual provider Active NPI

Bailey J Wetherell, DPT

  • Physical Therapist
  • Coralville, IA
National Provider Identifier
1962096883
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
107043 Issued in IA
Practice address
2769 Heartland Dr Ste 301
Coralville, IA 52241-2732
Phone
(319) 545-4121
Fax
(319) 545-4128
NPI assigned
Feb 22, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 107043 IA Primary

Addresses

Primary practice location

2769 Heartland Dr Ste 301
Coralville, IA 52241-2732

Mailing address

1130 S Scott Blvd Ste 1
Iowa City, IA 52240-2909
Phone (319) 354-2429

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

LicenseStateTypeSpecialty
107043IAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Rehabilitation Associates L.L.C. Physical Therapist CurrentSince Mar 26, 2023 Accepting new patients
Premier Physical Therapy of Iowa Physical Therapist CurrentSince Oct 29, 2023 Accepting new patients

Locations

2769 Heartland Dr
Ste 301
Coralville, IA 52241
Phone (319) 354-2429

1130 S Scott Blvd
Ste 1
Iowa City, IA 52240
Phone (319) 354-2429

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1962096883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 S SCOTT BLVD STE 1",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522402909",
            "telephone_number": "319-354-2429",
            "fax_number": "319-338-5775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2769 HEARTLAND DR STE 301",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412732",
            "telephone_number": "319-545-4121",
            "fax_number": "319-545-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETHERELL",
        "first_name": "BAILEY",
        "middle_name": "J",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "107043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coralville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; 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.