Tyler Wilbourn, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

3603 Issued in OK

Practice address

503 N Broadway St
Tecumseh, OK 74873-2017

Phone

(405) 598-2899

NPI assigned

Feb 27, 2023

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

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.

• Action Physical Therapy & Rehabilitation, PLLC

  • Physical Therapist
  • Shawnee, OK
  • NPI 1902103112
  NPD (past)

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1982303111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3675",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748023675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 N BROADWAY ST",
            "city": "TECUMSEH",
            "state": "OK",
            "postal_code": "748732017",
            "telephone_number": "405-598-2899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBOURN",
        "first_name": "TYLER",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-27",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OK",
            "license": "3603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Watson, DDS
• Steven Dean Weddle
• Patsy Ruth Wheatley-Grimes, MA SECONDARY ED
• Megan Wheeler
• Stephannie S White, P.T.
• Susan Marlo Williams, RN, IBCLC
• Ed Wingfield, DDS

• Physical Therapy Assistant in Tecumseh, OK
• Providers in Tecumseh, OK by specialty
• Physical Therapy Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.