Bespoke Physical Therapy, Wellness and Performance

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BESPOKE PHYSICAL THERAPY, WELLNESS AND PERFORMANCE

Practice address

17014 New College Ave Ste D
Wildwood, MO 63040-1177

Phone

(636) 500-7772

NPI assigned

Jan 22, 2026

Organization subpart

No

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

Authorized official

Name

Taylor Bushnell, DPTNPI 1558692566

Title

Owner/Physical Therapist

Phone

(636) 500-7772

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taylor Hamilton Bushnell, DPT

  • Physical Therapist
  • Wildwood, MO
  • NPI 1558692566

  MO, Single Specialty

  Medicare reassignment Care Compare group NPD Authorized official
• Zachary Boyle, DPT

  • Physical Therapist
  • Ballwin, MO
  • NPI 1710426432

  MO

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1769040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769385600000",
    "number": "1508715756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17014 NEW COLLEGE AVE STE D",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401177",
            "telephone_number": "636-500-7772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17014 NEW COLLEGE AVE STE D",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401177",
            "telephone_number": "636-500-7772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BESPOKE PHYSICAL THERAPY, WELLNESS AND PERFORMANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-22",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A",
        "authorized_official_last_name": "BUSHNELL",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "636-500-7772",
        "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": []
}

• Patrick J Bass, D.C.
• Christie A Bayer, MD
• Be Well Be Fit Chiropractic, LLC
• Deborah Allen Beffa, MS/CCC/SLP
• Rose Marie Bernardez, MSW, LCSW
• Abby Leanne Beyer
• Mary K Bland, SLP
• Bailee Bonastia, DPT
• Betty Bossaller, CRNFA
• Heather Marie Boutwell, RN

• All providers in Wildwood, MO
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; 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.