Active NPI
Colleen Joyce Wildenhain, MS, ATC
- Athletic Trainer
- Reston, VA
National Provider Identifier
1306325972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126001682
- Practice address
- 1850 Town Center Pkwy Ste 400
Reston, VA 20190-3219 - Phone
- (703) 810-5202
- NPI assigned
- Aug 14, 2018
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0126001682 | VA | Primary |
Addresses
Primary practice location
1850 Town Center Pkwy Ste 400
Reston, VA 20190-3219
Mailing address
1898 Winterport Cluster
Reston, VA 20191-3624
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0126001682 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534204800000",
"number": "1306325972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1898 WINTERPORT CLUSTER",
"city": "RESTON",
"state": "VA",
"postal_code": "201913624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1850 TOWN CENTER PKWY STE 400",
"city": "RESTON",
"state": "VA",
"postal_code": "201903219",
"telephone_number": "703-810-5202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDENHAIN",
"first_name": "COLLEEN",
"middle_name": "JOYCE",
"name_prefix": "Mrs.",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-14",
"last_updated": "2018-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126001682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.