Active NPI
Vicki Denice Wade, PT
- Physical Therapist
- Lawrenceville, GA
National Provider Identifier
1417424862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1073039
- Practice address
- 545 Old Norcross Rd Ste 100
Lawrenceville, GA 30046-3390 - Phone
- (678) 377-2833
- Fax
- (678) 377-2882
- NPI assigned
- Oct 24, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1073039 | TX | Primary |
Addresses
Primary practice location
545 Old Norcross Rd Ste 100
Lawrenceville, GA 30046-3390
Mailing address
665 Gallagher Rd
MC Queeney, TX 78123-3282
Phone (254) 541-2118
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 |
|---|---|---|---|
| 1073039 | TX | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687132800000",
"number": "1417424862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "665 GALLAGHER RD",
"city": "MC QUEENEY",
"state": "TX",
"postal_code": "781233282",
"telephone_number": "254-541-2118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "545 OLD NORCROSS RD STE 100",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300463390",
"telephone_number": "678-377-2833",
"fax_number": "678-377-2882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "VICKI",
"middle_name": "DENICE",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-24",
"last_updated": "2023-06-19",
"certification_date": "2023-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1073039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.