NPIMap

Organization Active NPI

Wiggle Worms Pediatric Physical Therapy, LLC

  • Speech-Language Pathologist
  • York, ME
National Provider Identifier
1063962116
Registry record updated Oct 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP2587 Issued in ME
Legal business name
WIGGLE WORMS PEDIATRIC PHYSICAL THERAPY, LLC
Practice address
764 US Route 1
Unit 4
York, ME 03909-5883
Phone
(207) 351-3083
Fax
(207) 351-3083
NPI assigned
Oct 12, 2016
Last updated
Oct 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2016

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

Authorized official

Name
Joan M Bastek
Title
Billing Specialist
Phone
(207) 351-3078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP2587 ME Primary

Addresses

Primary practice location

764 US Route 1
Unit 4
York, ME 03909-5883

Mailing address

764 US Route 1
Unit 4
York, ME 03909-5883
Phone (207) 351-3083

National Provider Directory

National Provider Directory
Tax ID family
Wiggle Worms Pediatric Physical Therapy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

764 US Route 1
Ste 4
York, ME 03909
Phone (207) 351-3078

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1063962116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "764 US ROUTE 1",
            "address_2": "UNIT 4",
            "city": "YORK",
            "state": "ME",
            "postal_code": "039095883",
            "telephone_number": "207-351-3083",
            "fax_number": "207-351-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "764 US ROUTE 1",
            "address_2": "UNIT 4",
            "city": "YORK",
            "state": "ME",
            "postal_code": "039095883",
            "telephone_number": "207-351-3083",
            "fax_number": "207-351-3083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIGGLE WORMS PEDIATRIC PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "BASTEK",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "207-351-3078"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ME",
            "license": "SP2587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in York, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; 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.