Jason M Wambold, MSPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

028339 Issued in NY

Practice address

807 Ridge Rd Ste B
Webster Woods Plaza
Webster, NY 14580-2497

Phone

(585) 347-0202

NPI assigned

Jul 19, 2006

Last updated

Sep 24, 2013By the provider in NPPES

Sex

Male

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)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sports Physical Therapy of New York, PC

  • Physical Therapist
  • Webster, NY
  • NPI 1760770606
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379980800000",
    "number": "1417976689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7702 WHISPERS LN",
            "city": "ONTARIO",
            "state": "NY",
            "postal_code": "145198701",
            "telephone_number": "585-455-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 RIDGE RD STE B",
            "address_2": "WEBSTER WOODS PLAZA",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145802497",
            "telephone_number": "585-347-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAMBOLD",
        "first_name": "JASON",
        "middle_name": "M",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2013-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "028339",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "PA",
            "license": "013146",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "028339",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1744)
• Wal-Mart Stores East, LP (Vision Center 30-1744)
• Walgreen Co (Rite Aid #10855)
• Walgreen Co (Walgreens #09872)
• Pamela J. Walpole, R.PH.
• Brooke Lee Ward
• Charles Benedict Wardell, RPH
• Stacy Wardell, RPH
• Warming Hearts Care
• Daniel Warner

• Physical Therapist in Webster, NY
• Providers in Webster, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; 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.