Jeffrey Gary Wang, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

303192 Issued in CA

Practice address

1460 Drew Ave Ste 200
Davis, CA 95618-4856

Phone

(530) 753-9011

Fax

(530) 753-9021

NPI assigned

Nov 17, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physical Edge, Inc.Group PAC ID 7214990399, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Physical Edge, Inc.

  • Physical Therapist
  • Davis, CA
  • NPI 1770675639
  Medicare reassignment Care Compare group NPD
• Physical Edge Specialty Services

  • Physical Therapist
  • Davis, CA
  • NPI 1740894005
  NPD

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

{
    "created_epoch": "1668643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668643200000",
    "number": "1194434118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 DREW AVE STE 200",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956184856",
            "telephone_number": "530-753-9011",
            "fax_number": "530-753-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 DREW AVE STE 200",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956184856",
            "telephone_number": "530-753-9011",
            "fax_number": "530-753-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "JEFFREY",
        "middle_name": "GARY",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-17",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "303192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth C Wallis, M.D.
• David T. Walters, MD
• Kayla Jackie Brenya Walton
• Ashley C Wang, PHARM D.
• Erjun Wang, M.D.
• Johsin Wang, PHARMD
• Valeria Wang, PA-C
• Yuyan Wang
• Aaron Zachary Ward, PH.D.
• Erica N Waterford, B.A.

• Physical Therapist in Davis, CA
• Providers in Davis, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.