Active NPI
Wade Vandover, P.T.
- Physical Therapist
- Big Stone City, SD
National Provider Identifier
1174550446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4675
- Practice address
- 500 Cross St
Big Stone City, SD 57216-8237 - Phone
- (605) 541-1115
- Fax
- (605) 541-0109
- NPI assigned
- Jun 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0383 | SD | |
| Physical Therapist | 225100000X | 4675 | MN | Primary |
Addresses
Primary practice location
500 Cross St
Big Stone City, SD 57216-8237
Mailing address
820 Roy St
Ortonville, MN 56278-1138
Phone (320) 830-4271
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0383 | SD | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BST Albert Lea, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651104000000",
"number": "1174550446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 ROY ST",
"city": "ORTONVILLE",
"state": "MN",
"postal_code": "562781138",
"telephone_number": "320-830-4271",
"fax_number": "320-839-4196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 CROSS ST",
"city": "BIG STONE CITY",
"state": "SD",
"postal_code": "572168237",
"telephone_number": "605-541-1115",
"fax_number": "605-541-0109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDOVER",
"first_name": "WADE",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-26",
"last_updated": "2022-04-28",
"certification_date": "2022-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SD",
"license": "0383",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "4675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Big Stone City, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.