Wild Physical Therapy and Wellness LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

WILD PHYSICAL THERAPY AND WELLNESS LLC

Practice address

545 Pawtucket Ave # Ll04A
Pawtucket, RI 02860-6046

Phone

(812) 662-5033

NPI assigned

Jul 9, 2024

Organization subpart

No

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

Authorized official

Name

Mollye Leas-Medrek, DPTNPI 1346638103

Title

Owner

Phone

(812) 662-5033

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mollye R Leas-Medrek

  • Physical Therapist
  • Warwick, RI
  • NPI 1346638103
  NPD Authorized official

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

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1174360176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N MAIN ST # 1439",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029045722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 PAWTUCKET AVE # LL04A",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028606046",
            "telephone_number": "812-662-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD PHYSICAL THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "LEAS-MEDREK",
        "authorized_official_first_name": "MOLLYE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-662-5033",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert White, RPH, CDOE
• Lee Miriam Whitman-Raymond, PHD
• Robert Green Whitman-Raymond, MSW, CAS
• Whole Health Physical Therapy
• Wild Heart Marriage & Family Counseling
• Wild Rose Therapy, LLC
• Brian Wiley, DO
• Carrie Williams, MASTERS
• Christine Lucene Williams, LICSW
• Edward Williams, MASTERS

• Physical Therapist in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Physical Therapist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.