Brooke Elizabeth Wilde, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2018029941 Issued in MO

Practice address

100 Frist CT
Columbus, GA 31909-3578

Phone

(704) 494-2100

NPI assigned

Apr 23, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1083278345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 TURNBERRY DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651094531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 FRIST CT",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319093578",
            "telephone_number": "704-494-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 E Harris Ave",
            "address_purpose": "LOCATION",
            "city": "San Angelo",
            "state": "TX",
            "postal_code": "769035904",
            "country_code": "US",
            "telephone_number": "325-653-6741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDE",
        "first_name": "BROOKE",
        "middle_name": "ELIZABETH",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-23",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2018029941",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1304742",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Wilbert
• Dayna Wilburn
• Rodrick T Wilburn Jr.
• Taniya Sonora Wilburn
• Stephanie Allyn Wilcox, PHARM.D.
• Taylor Wilde
• Caley Wiley
• Kathryn Dudley Wiley, ACPNP-C
• Wendy Wiley
• Ariana N Wilkerson

• Physical Therapist in Columbus, GA
• Providers in Columbus, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.