Michael Wirth, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

033990 Issued in NY

Practice address

650 Hawkins Ave
Ste 4
Lake Ronkonkoma, NY 11779-2366

Phone

(631) 981-7422

Fax

(631) 981-2490

NPI assigned

Nov 12, 2012

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 NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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.

• Wirth Physical Therapy PC

  • Physical Therapist
  • Lake Ronkonkoma, NY
  • NPI 1851958490
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1352678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544054400000",
    "number": "1306180583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 HAWKINS AVE",
            "address_2": "STE 4",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792366",
            "telephone_number": "631-981-7422",
            "fax_number": "631-981-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HAWKINS AVE",
            "address_2": "STE 4",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792366",
            "telephone_number": "631-981-7422",
            "fax_number": "631-981-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRTH",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-12",
        "last_updated": "2018-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "033990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie Wigutow
• Jennifer Grace Wiley
• Maureen Wilmott, RN
• Eileen Wilson
• Wirth Physical Therapy PC
• Kimberlie A Wottawa, LMSW
• Michelle L Young

• Physical Therapist in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; 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.