John David Wild Jr., DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

08568 Issued in LA

Practice address

510 W Pine St
Ponchatoula, LA 70454-3738

Phone

(985) 634-1966

NPI assigned

May 21, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anatomix Physical Therapy IncGroup PAC ID 3971576133, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Anatomix Physical Therapy Inc

  • Physical Therapist
  • Hammond, LA
  • NPI 1376577015
  Medicare reassignment Care Compare group NPD
• Anatomix Physical Therapy-Mandeville LLC

  • Physical Therapist
  • Mandeville, LA
  • NPI 1114462694
  Medicare reassignment NPD

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1508245606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 W PINE ST",
            "city": "PONCHATOULA",
            "state": "LA",
            "postal_code": "704543738",
            "telephone_number": "985-634-1966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 W PINE ST",
            "city": "PONCHATOULA",
            "state": "LA",
            "postal_code": "704543738",
            "telephone_number": "985-634-1966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "08568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larrion Nicole Weatherspoon, FNP
• Esther Wee
• Britley Dru Wells, BSN RN
• Victoria M White
• James Michael Whittington, NP
• Wilkinson Care Giving LLC
• Christopher Seth Williams
• Donald Wayne Williams Jr., PHARM D
• Latasha Williams
• Lila Williams, DPT

• Physical Therapist in Ponchatoula, LA
• Providers in Ponchatoula, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.