Kendall E Wilde, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT013169 Issued in GA

Practice address

1615 Ridenour Blvd NW Ste 204
Kennesaw, GA 30152-4464

Phone

(770) 580-8070

Fax

(770) 285-8751

NPI assigned

Sep 19, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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.

• PT Solutions of Acworth LLC

  • Physical Therapist
  • Kennesaw, GA
  • NPI 1184075210
  NPD (past)
• PT Solutions of Acworth, LLC

  • Physical Therapist
  • Dallas, GA
  • NPI 1891161352
  NPD (past)

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508457600000",
    "number": "1417405499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8541 E ANDERSON DR STE 100",
            "address_2": "STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852555430",
            "telephone_number": "480-585-6810",
            "fax_number": "480-585-6910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 RIDENOUR BLVD NW STE 204",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524464",
            "telephone_number": "770-580-8070",
            "fax_number": "770-285-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "KENDALL",
        "middle_name": "E",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-19",
        "last_updated": "2017-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT013169",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "12414",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "PT013169",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Whitner
• Whittle Chiropractic Ctr., Inc. (The Wellpath Center)
• Elaine Atkins Whitworth, LMSW,LPC
• Nicolas A. Wieder, DO
• Tanya S Wilcox, NP
• Raymon Joel Wilensky, M.D.
• Lesley Orman Wilkerson, MD
• Janna Williams-Pitts, PHD
• Anthony Williams, PHARMD.
• Daniel Williams, DPT

• Physical Therapist in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2017; 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.