Katie Lynn Wilson, PT, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

1232246 Issued in TX

Practice address

100 E Ferguson St Ste 1204
Tyler, TX 75702-5700

Phone

(903) 509-2040

NPI assigned

Apr 30, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• East Texas Pediatric Rehabilitation Associates Inc

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Tyler, TX
  • NPI 1871654244
  NPD (past)

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520121600000",
    "number": "1972980779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E FERGUSON ST STE 1204",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757025700",
            "telephone_number": "903-509-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E FERGUSON ST STE 1204",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757025700",
            "telephone_number": "903-509-2040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Wsw Loop 323",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757019416",
            "country_code": "US",
            "telephone_number": "903-509-1313",
            "fax_number": "903-509-1383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KATIE",
        "middle_name": "LYNN",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-30",
        "last_updated": "2018-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "TX",
            "license": "1232246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972980779",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary Wilson, MD
• Jaclyn Wilson
• James Michael Wilson, MD, MPH
• Javieon Wilson
• Jeremiah Brandon Wilson, CRNA
• Madison Wilson
• Mary Wilson
• Miriam G Wilson
• Oscar Ray Wilson, MD
• Prema Wilson, AGACNP

• Pediatric Physical Therapist in Tyler, TX
• Providers in Tyler, TX by specialty
• Pediatric Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2018; 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.