Jack Anthony Wilder, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PT00009619 Issued in WA

Practice address

405 Black Hills LN SW
Suite G
Olympia, WA 98502-8661

Phone

(360) 956-2562

Fax

(360) 956-1894

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326269739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 77TH CT SE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985019697",
            "telephone_number": "360-455-9068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BLACK HILLS LN SW",
            "address_2": "SUITE G",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028661",
            "telephone_number": "360-956-2562",
            "fax_number": "360-956-1894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "JACK",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "WA",
            "license": "PT00009619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine Wigley, MT
• Patricia Anne Wilburn, LMP
• Micah Wilcox
• Shannon Nicole Wilcox, PT
• Beth Wilder, OTR/L
• James Robert Wilder, DMD
• Wildflower Telehealth Network Inc.
• Wildwood Speech Therapy LLC
• Elizabeth Ann Wiley, MD, JD, MPH
• Jana Lyn Wiley, L.AC.

• Orthopedic Physical Therapist in Olympia, WA
• Providers in Olympia, WA by specialty
• Orthopedic Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.