Active NPI
Paul Anthony Wambold, PT
- Physical Therapist
- Madison, WI
National Provider Identifier
1508956855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070020702
- Practice address
- 4602 Eastpark Blvd
Madison, WI 53718-2002 - Phone
- (608) 440-6440
- NPI assigned
- Oct 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7368 | MN | |
| Physical Therapist | 225100000X | 070020702 | IL | Primary |
Addresses
Primary practice location
4602 Eastpark Blvd
Madison, WI 53718-2002
Mailing address
4602 Eastpark Blvd
Madison, WI 53718-2002
Phone (608) 440-6440
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1508956855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4602 EASTPARK BLVD",
"city": "MADISON",
"state": "WI",
"postal_code": "537182002",
"telephone_number": "608-440-6440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4602 EASTPARK BLVD",
"city": "MADISON",
"state": "WI",
"postal_code": "537182002",
"telephone_number": "608-440-6440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAMBOLD",
"first_name": "PAUL",
"middle_name": "ANTHONY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-14",
"last_updated": "2021-04-23",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "7368",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070020702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.