DR. THADDEUS EARL WILSON (NPI# 1184839896) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184839896 |
| Entity Type | Individual |
| Full Name | DR. THADDEUS EARL WILSON |
| Credential | M.D. |
| Practice Address |
11406 Loma Linda Dr Physical Medicine and Rehabilitation Loma Linda CA 92354-3711 |
| Mailing Address |
11406 Loma Linda Drive Physical Medicine and Rehabilitation Loma Linda CA 92354 |
| Practice Telephone | 9095586275 |
| Practice Fax Number | 9095586212 |
| Mailing Telephone | 9095586275 |
| Mailing Fax Number | 9095586212 |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2014-08-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081P0010X |
Physical Medicine & Rehabilitation Specialization: Pediatric Rehabilitation Medicine |
A102261 | CA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417190869 | Thaddeus David Wilson | Emergency Medicine | 4204 Gardendale St, Suite 312, San Antonio, TX 78229-3132 | 2009-04-15 |
| Street Address |
11406 LOMA LINDA DR PHYSICAL MEDICINE AND REHABILITATION |
| City | LOMA LINDA |
| State | CA |
| Zip Code | 92354-3711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932168655 | Dave Lynaeus Tan | Physical Therapist | 11406 Loma Linda Dr, West Entrance, Loma Linda, CA 92354-3711 | 2006-03-21 |
| 1396342960 | Jeffrey Ryan Murray | Clinical Neuropsychologist | 11406 Loma Linda Dr, Loma Linda, CA 92354-3711 | 2020-10-06 |
| 1942775929 | Edna Sonya Barrett | Physical Therapist | 11406 Loma Linda Dr, Loma Linda, CA 92354-3711 | 2018-10-05 |
| 1205364106 | Caitlin Linas Medes | Occupational Therapist | 11406 Loma Linda Dr, Loma Linda, CA 92354-3711 | 2017-05-23 |
| 1164876918 | Joshua Nelson Speirs | Student in an Organized Health Care Education/Training Program | 11406 Loma Linda Dr, Suite 213, Loma Linda, CA 92354-3711 | 2016-04-18 |
| 1427465327 | Shawn Michael Teran | Student in an Organized Health Care Education/Training Program | 11406 Loma Linda Dr, Room 516, Loma Linda, CA 92354-3711 | 2014-07-13 |
| 1992065940 | Joseph Johnson | Orthopaedic Surgery | 11406 Loma Linda Dr, Loma Linda, CA 92354-3711 | 2012-05-24 |
| 1144589839 | Davin Yah-ming Chu | Physical Medicine & Rehabilitation | 11406 Loma Linda Dr, Suite 516, Loma Linda, CA 92354-3711 | 2012-05-15 |
| 1154689248 | Joseph Liu | Orthopaedic Surgery | 11406 Loma Linda Dr, Loma Linda, CA 92354 | 2012-04-26 |
| 1245531367 | Summer San Lucas | Physical Therapist | 11406 Loma Linda Dr, West Entrance, Loma Linda, CA 92354-3711 | 2010-11-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588264337 | Apple Red Nutrition Services | Dietitian, Registered | 357 W. 2nd St, Suite #2, Loma Linda, CA 92354 | 2020-10-30 |
| 1013517960 | Kristina Pulliam Markey | Nurse Practitioner | 11234 Anderson Strreet, Loma Linda, CA 92354 | 2020-10-29 |
| 1932725645 | Dev Priya Singhvi | Student in an Organized Health Care Education/Training Program | 11332 Mountain View Avenue, Westerly Building, Suite C, Gme Office, Loma Linda, CA 92354 | 2020-06-18 |
| 1750901278 | Angela N Torres | Student in an Organized Health Care Education/Training Program | Loma Linda University Health Emergency Medicine, 11234 Anderson Street, Loma Linda, CA 92354 | 2020-04-24 |
| 1548899230 | Holistic Physical Therapy Inc. | Physical Therapist | 25003 Starr Str, Loma Linda, CA 92354 | 2020-04-03 |
| 1508494071 | Eric Allen | Student in an Organized Health Care Education/Training Program | Loma Linda University Health Pediatrics, General, 11234 Anderson Street, Loma Linda, CA 92354 | 2020-03-31 |
| 1730640244 | Rose Valley Rcfe | Assisted Living Facility | 11574 Poplar St, Loma Linda, CA 92354 | 2019-03-27 |
| 1336633676 | David A Lawrence | Student in an Organized Health Care Education/Training Program | Loma Linda University Hospital, 11234 Anderson St., Loma Linda, CA 92354 | 2018-06-20 |
| 1205329547 | Rachael Nicole Spady | Student in an Organized Health Care Education/Training Program | Loma Linda University Health - Obstetrics & Gynecology, 11234 Anderson St, Loma Linda, CA 92354 | 2018-06-12 |
| 1447756069 | Anthony Ernest Sanchez | Otolaryngology | 11332 Mountain View, Westerly Building Suite C, Loma Linda, CA 92354 | 2018-04-03 |
| Find all providers in zip 92354 | ||||
| Taxonomy Code | 2081P0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pediatric Rehabilitation Medicine |
| A physiatrist who utilizes an interdisciplinary approach and addresses the prevention, diagnosis, treatment and management of congenital and childhood-onset physical impairments including related or secondary medical, physical, functional, psychosocial and vocational limitations or conditions, with an understanding of the life course of disability. This physician is trained in the identification of functional capabilities and selection of the best of rehabilitation intervention strategies, with an understanding of the continuum of care. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate for PRM was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Early discussions underway |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366925117 | Christine Marie Draper | Physical Medicine & Rehabilitation | 1900 Garden Rd Ste 200-c, Monterey, CA 93940-5373 | 2018-09-07 |
| 1922272525 | Elaine L Pico, M.d. | Physical Medicine & Rehabilitation | 2825 International Blvd, Room Rc121, Oakland, CA 94601-1543 | 2008-04-15 |
| 1295910941 | University Childrens Medical Group | Physical Medicine & Rehabilitation | 4650 W Sunset Blvd # 5, Los Angeles, CA 90027-6062 | 2007-12-31 |
| 1528080462 | Elaine Louise Pico | Physical Medicine & Rehabilitation | 3031 Telegraph Ave Ste 241, Berkeley, CA 94705-2053 | 2006-07-23 |
| 1205390655 | Rachel Sara Christensen | Physical Medicine & Rehabilitation | 1195 W Fremont Ave, Sunnyvale, CA 94087-3832 | 2019-01-29 |
| 1891265989 | Doreen Spearman | Physical Medicine & Rehabilitation | 34590 County Line Rd Ste 7, Yucaipa, CA 92399-5398 | 2018-11-30 |
| 1316445885 | Amy Quach | Physical Medicine & Rehabilitation | 8933 Activity Rd, San Diego, CA 92126-4427 | 2018-01-30 |
| 1619407459 | Shannon O'brien | Physical Medicine & Rehabilitation | 26081 Merit Cir Ste 107, Laguna Hills, CA 92653-7017 | 2017-06-14 |
| 1851844278 | Karen Charlotta Albiston | Physical Medicine & Rehabilitation | 3355 Mission Ave Ste 123, Oceanside, CA 92058-1327 | 2016-08-02 |
| 1033573126 | Faheem Mahomed | Physical Medicine & Rehabilitation | 4860 Y St Ste 3850, Sacramento, CA 95817-2307 | 2016-04-05 |
| Find all providers with the same taxonomy | ||||
| City | LOMA LINDA |
| Zip Code | 92354 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.