Active NPI
Vanessa Marie Waddle, LPTA
- Physical Therapy Assistant
- Piketon, OH
National Provider Identifier
1023357597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2488
- Practice address
- 300 Overlook Dr
Piketon, OH 45661-9760 - Phone
- (740) 289-4074
- NPI assigned
- Feb 4, 2013
- Last updated
- Feb 4, 2013
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2488 | OH | Primary |
Addresses
Primary practice location
300 Overlook Dr
Piketon, OH 45661-9760
Mailing address
300 Overlook Dr
Piketon, OH 45661-9760
Phone (740) 289-4074
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2488 | Other | OH | OTPTAT BOARD |
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 |
|---|---|---|---|
| 2488 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359936000000",
"number": "1023357597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 OVERLOOK DR",
"city": "PIKETON",
"state": "OH",
"postal_code": "456619760",
"telephone_number": "740-289-4074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 OVERLOOK DR",
"city": "PIKETON",
"state": "OH",
"postal_code": "456619760",
"telephone_number": "740-289-4074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADDLE",
"first_name": "VANESSA",
"middle_name": "MARIE",
"credential": "LPTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-02-04",
"last_updated": "2013-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "2488",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTPTAT BOARD",
"identifier": "2488",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Piketon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.