Mary W Wildermuth, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1703 Issued in SC

Practice address

9250 A Highway 17 Bypass
Murrells Inlet, SC 29576-9326

Phone

(843) 215-8787

Fax

(843) 215-8670

NPI assigned

May 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Low Country Physical Therapy

  • Physical Therapist
  • Murrells Inlet, SC
  • NPI 1639102312
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191888000000",
    "number": "1326091968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9250 A HIGHWAY 17 BYPASS",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295769326",
            "telephone_number": "843-215-8787",
            "fax_number": "843-215-8670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9250 A HIGHWAY 17 BYPASS",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295769326",
            "telephone_number": "843-215-8787",
            "fax_number": "843-215-8670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDERMUTH",
        "first_name": "MARY",
        "middle_name": "W",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2007-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "1703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TH0328",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Keesley Welchel
• Jacob Welker Dakota Welker
• William K Whiteside, MD
• Caleb Sims Whitney, ATC
• Amy R Wielkopolan, LMBT
• Jeffrey C. Wilkins, MD
• George A Wilkinson Jr., MD
• Christina Williams-Kea
• Edward Joseph Williams Jr., DO
• Jennifer Gore Williams, PHARM D

• All providers in Murrells Inlet, SC
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.