NPIMap

Organization Active NPI

Wildwood Medicine

  • Physical Therapist
  • Portland, ME
National Provider Identifier
1063671121
Registry record updated Sep 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT3116 Issued in ME
Legal business name
WILDWOOD MEDICINE
Practice address
83 India St
Portland, ME 04101-4210
Phone
(207) 347-7132
Fax
(207) 839-2197
NPI assigned
Jun 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2014

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

Authorized official

Name
Mr. Daniel Katz, PT NC
Title
President
Phone
(207) 347-7132

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X AC281 ME
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X AC308 ME
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT3116 ME Primary

Addresses

Primary practice location

83 India St
Portland, ME 04101-4210

Mailing address

PO Box 7412
Portland, ME 04112
Phone (207) 347-7132

National Provider Directory

National Provider Directory

Locations

97 India St
Portland, ME 04101
Phone (207) 347-7132

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1212537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410134400000",
    "number": "1063671121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04112",
            "telephone_number": "207-347-7132",
            "fax_number": "207-839-2197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 INDIA ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014210",
            "telephone_number": "207-347-7132",
            "fax_number": "207-839-2197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-04",
        "last_updated": "2014-09-08",
        "status": "A",
        "authorized_official_last_name": "KATZ",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-347-7132",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT NC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "ME",
            "license": "AC281",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "ME",
            "license": "AC308",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT3116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; 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.