Tesa Wilder

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT133884 Issued in TX

Practice address

310 River Bluff Cir
Georgetown, TX 78626-4617

Phone

(325) 450-7863

NPI assigned

Dec 30, 2020

Last updated

Dec 30, 2020By the provider in NPPES

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

Electronic endpoints 1

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": "1609286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1407443922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 RIVER BLUFF CIR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786264617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 RIVER BLUFF CIR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786264617",
            "telephone_number": "325-450-7863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "TESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-30",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "TX",
            "license": "MT133884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "wellness.by.wilder@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "310 River Bluff Cir",
            "city": "Georgetown",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786264617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Whole Body Psychotherapy
• Ashton Senathi Wickramasinghe, MD
• Hannah Meckenzie Wideman
• Corinne Marguerite Wier, LPC
• Casey Wilburn, BS, CLS
• Candace Wiley, BCBA
• Anne E Wilkerson, M.D.
• Melisa Willek
• Kimberly Willhoite
• William R. Baechtel, MD,PA

• Massage Therapist in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Massage Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2020; 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.