Jessica Wallbaum

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160008001 Issued in IL

Practice address

1525 E Main St
Streator, IL 61364-3162

Phone

(815) 672-4516

NPI assigned

Feb 22, 2019

Sex

Female

Sole proprietor

No

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": "1550793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550793600000",
    "number": "1962969246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E MAIN ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613643162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E MAIN ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613643162",
            "telephone_number": "815-672-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLBAUM",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-22",
        "last_updated": "2019-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.008001",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160008001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven J Trzepacz, O.D.
• Two Rivers Outreach
• U K Sinha, M.D., S.C.
• Jessica Anne Verduzco
• Walgreen Co
• Walmart Inc.
• Mark A Wargo, M.D.
• Marissa Dyanne Weaver, CRNA
• Trent Ryan Weeks, PHARMD
• Western Illinois ENT and Allergy

• Physical Therapy Assistant in Streator, IL
• Providers in Streator, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; 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.