NPIMap

Organization Active NPI

Dawn Marie Wildermuth

Doing business as Suncoast Therapy

  • Specialist
  • Venice, FL
National Provider Identifier
1235331075
Registry record updated Jul 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
DAWN MARIE WILDERMUTH
Doing business as
Suncoast Therapy
Practice address
411 Commercial CT
Ste F
Venice, FL 34292-1650
Phone
(941) 468-6701
Fax
(941) 485-0519
NPI assigned
Jun 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2008

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

Authorized official

Name
Dawn Wildermuth, MS CCC/SLPNPI 1568556033
Title
Owner
Phone
(941) 468-6701

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

411 Commercial CT
Ste F
Venice, FL 34292-1650

Mailing address

411 Commercial CT
Ste F
Venice, FL 34292-1650
Phone (941) 468-6701

Other identifiers 2

IdentifierTypeStateIssuer
886436500MedicaidFL
S1872OtherFLBC/BS

Other names 1

  • Suncoast Therapy Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215129600000",
    "number": "1235331075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 COMMERCIAL CT",
            "address_2": "STE F",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342921650",
            "telephone_number": "941-468-6701",
            "fax_number": "941-485-0519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 COMMERCIAL CT",
            "address_2": "STE F",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342921650",
            "telephone_number": "941-468-6701",
            "fax_number": "941-485-0519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAWN MARIE WILDERMUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2008-07-04",
        "status": "A",
        "authorized_official_last_name": "WILDERMUTH",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-468-6701",
        "authorized_official_credential": "MS CCC/SLP"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "886436500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "S1872",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suncoast Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2008; 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.