Derek James Wasden, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

9005 Issued in ID

Practice address

943 N Linder Rd Ste 104
Kuna, ID 83634-3395

Phone

(208) 972-4612

Fax

(208) 991-1595

NPI assigned

May 31, 2024

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 ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Current Physical Therapy Kuna LLCGroup PAC ID 3971901331, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Current Physical Therapy Kuna LLC

  • Physical Therapist
  • Kuna, ID
  • NPI 1821661927
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1717113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1215778667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "943 N LINDER RD STE 104",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836343395",
            "telephone_number": "208-972-4612",
            "fax_number": "208-991-1595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 N LINDER RD STE 104",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836343395",
            "telephone_number": "208-972-4612",
            "fax_number": "208-991-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASDEN",
        "first_name": "DEREK",
        "middle_name": "JAMES",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-31",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "9005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #13614)
• Jeremy Walker, DMD
• Kirsten Wallin
• Edward Walthall, PHARMD
• Travis Walthall, RPH
• Jessica Watkins, LPC
• Kailah Paige Watson
• Imelda Joan Weddington, NP
• Jamie Lynn Widman, PA-S
• Kelsey M Willbur

• Physical Therapist in Kuna, ID
• Providers in Kuna, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; 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.