Physialign LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PHYSIALIGN LLC

Practice address

1233 Shelburne Rd Ste 190
South Burlington, VT 05403-7733

Phone

(802) 318-0581

Fax

(802) 448-5951

NPI assigned

Apr 15, 2019

Last updated

Dec 26, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lauren Wedam, PT, DPTNPI 1811208135

Title

Authorized Agent

Phone

(802) 318-0581

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• PhysiAlign Former legal business name

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Locations

Practitioners 1

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.

• Lauren M Wedam, DPT

  • Geriatric Physical Therapist
  • South Burlington, VT
  • NPI 1811208135
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577318400000",
    "number": "1093378168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64823",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054064823",
            "telephone_number": "802-318-0581",
            "fax_number": "802-448-5951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 SHELBURNE RD STE 190",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037733",
            "telephone_number": "802-318-0581",
            "fax_number": "802-448-5951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "K12 Stonehedge Dr",
            "address_purpose": "LOCATION",
            "city": "South Burlington",
            "state": "VT",
            "postal_code": "054037371",
            "country_code": "US",
            "telephone_number": "802-735-7145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSIALIGN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-15",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A",
        "authorized_official_last_name": "WEDAM",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "802-318-0581",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VT LICENCE NUMBER",
            "identifier": "040.0066530",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PhysiAlign",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Philip Lynn Pezeshki
• Nancy Phelan, P.T.
• Michael Phillips, PA
• Phoenix Physical Therapy PLLC
• Phoenix Psychotherapy LLC
• Physical Therapy Center of Vermont LLC (The Edge Physical Therapy)
• Bethany Juscen Pike, CMT
• Pillsbury Associates, Inc (Pillsbury Manor)
• Christianna M Pilsucki, LICSW
• Pincombe & Willis (802 Eye Care)

• Physical Therapy Clinic/Center in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Physical Therapy Clinic/Center in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.