Active NPI
Debora Carol Wild, PT
- Physical Therapist
- Lackawanna, NY
National Provider Identifier
1235595372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 62 009043
- Practice address
- 55 Melroy Ave
Lackawanna, NY 14218-1658 - Phone
- (716) 819-5036
- NPI assigned
- Jan 5, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 62 009043 | NY | Primary |
Addresses
Primary practice location
55 Melroy Ave
Lackawanna, NY 14218-1658
Mailing address
59 Frances St
Tonawanda, NY 14150-4016
Phone (716) 696-2008
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62 009043 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451952000000",
"number": "1235595372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "59 FRANCES ST",
"city": "TONAWANDA",
"state": "NY",
"postal_code": "141504016",
"telephone_number": "716-696-2008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 MELROY AVE",
"city": "LACKAWANNA",
"state": "NY",
"postal_code": "142181658",
"telephone_number": "716-819-5036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILD",
"first_name": "DEBORA",
"middle_name": "CAROL",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-05",
"last_updated": "2016-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "62 009043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackawanna, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.