Active NPI
Jeffrey L Wold, PT
- Physical Therapist
- Fargo, ND
National Provider Identifier
1578509899
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 473
- Practice address
- 2301 25TH St S
Fargo, ND 58103-6104 - Phone
- (701) 280-2212
- Fax
- (701) 271-1023
- NPI assigned
- Jun 22, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 473 | ND | Primary |
Addresses
Primary practice location
2301 25TH St S
Fargo, ND 58103-6104
Mailing address
2301 25TH St S
Fargo, ND 58103-6104
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00062409 | Other | ND | RAILROAD MEDICARE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 473 | ND | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabauthority, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201737600000",
"number": "1578509899",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2301 25TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 25TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036104",
"telephone_number": "701-280-2212",
"fax_number": "701-271-1023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLD",
"first_name": "JEFFREY",
"middle_name": "L",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2008-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "473",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00062409",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.