Active NPI
Ingrid Charlotte Wilson
- Massage Therapist
- San Diego, CA
National Provider Identifier
1972155406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 28480
- Practice address
- 5210 Balboa Ave Ste F
San Diego, CA 92117-6958 - Phone
- (619) 239-5433
- Fax
- (619) 546-5422
- NPI assigned
- Jul 15, 2019
- Last updated
- Jul 15, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 28480 | CA | Primary |
Addresses
Primary practice location
5210 Balboa Ave Ste F
San Diego, CA 92117-6958
Mailing address
10882 Macouba PL
San Diego, CA 92124-2043
Phone (619) 964-4325
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
| License | State | Type | Specialty |
|---|---|---|---|
| 28480 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563148800000",
"number": "1972155406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10882 MACOUBA PL",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921242043",
"telephone_number": "619-964-4325",
"fax_number": "858-569-8626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5210 BALBOA AVE STE F",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921176958",
"telephone_number": "619-239-5433",
"fax_number": "619-546-5422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "INGRID",
"middle_name": "CHARLOTTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-15",
"last_updated": "2019-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "28480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.