NPIMap

Organization Active NPI

New Edge Physical Therapy Inc

Doing business as Wildwood Physical Therapy Inc

  • Physical Therapist
  • Penn Valley, CA
National Provider Identifier
1477196111
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
NEW EDGE PHYSICAL THERAPY INC
Doing business as
Wildwood Physical Therapy Inc
Wildwood Physical Therapy, Inc
Practice address
11392 Pleasant Valley Rd
Penn Valley, CA 95946-9001
Phone
(530) 432-9660
NPI assigned
Oct 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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

Authorized official

Name
Tamsyn N Miller, DPTNPI 1619115276
Title
Owner
Phone
(530) 432-9660

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

11392 Pleasant Valley Rd
Penn Valley, CA 95946-9001

Mailing address

11392 Pleasant Valley Rd
Penn Valley, CA 95946-9001
Phone (530) 432-9660

Other names 2

  • Wildwood Physical Therapy Inc Doing business as
  • Wildwood Physical Therapy, Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200327002724 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830528751 Receives reassigned benefits from 3 practitioners
Practice locations: Penn Valley, CA

National Provider Directory

National Provider Directory

Locations

11392 Pleasant Valley Rd
Penn Valley, CA 95946
Phone (530) 432-9660

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585180800000",
    "number": "1477196111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11392 PLEASANT VALLEY RD",
            "city": "PENN VALLEY",
            "state": "CA",
            "postal_code": "959469001",
            "telephone_number": "530-432-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11392 PLEASANT VALLEY RD",
            "city": "PENN VALLEY",
            "state": "CA",
            "postal_code": "959469001",
            "telephone_number": "530-432-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW EDGE PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-25",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "TAMSYN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-432-9660",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wildwood Physical Therapy Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wildwood Physical Therapy, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wildwood Physical Therapy, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Penn Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.