Active NPI
Jessica Marie Vandermyde, PT, DPT
- Physical Therapist
- Miami, FL
National Provider Identifier
1356066328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT35310
- Practice address
- 13747 SW 31St Ter
Miami, FL 33175 - Phone
- (305) 546-5604
- NPI assigned
- Oct 11, 2022
- Last updated
- Jun 28, 2024
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05013652A | IN | |
| Developmental Therapist | 222Q00000X | |||
| Physical Therapist | 225100000X | 303437 | CA | |
| Physical Therapist | 225100000X | PT03501 | RI | |
| Physical Therapist | 225100000X | PT35310 | FL | Primary |
Addresses
Primary practice location
13747 SW 31St Ter
Miami, FL 33175
Mailing address
13747 SW 31St Ter
Miami, FL 33175-8804
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 |
|---|---|---|---|
| 303437 | CA | MD | Physical Therapist |
| PT35310 | FL | MD | Physical Therapist |
| 05013652A | IN | MD | Physical Therapist |
| PT03501 | RI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Early Navigators | Developmental Therapist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719532800000",
"number": "1356066328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13747 SW 31ST TER",
"city": "MIAMI",
"state": "FL",
"postal_code": "331758804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13747 SW 31ST TER",
"city": "MIAMI",
"state": "FL",
"postal_code": "33175",
"telephone_number": "305-546-5604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERMYDE",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-11",
"last_updated": "2024-06-28",
"certification_date": "2024-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05013652A",
"primary": false
},
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "303437",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "RI",
"license": "PT03501",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT35310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.