Amanda Wieder, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT36566 Issued in FL

Practice address

1215 E Orange St
Lakeland, FL 33801-5762

Phone

(863) 802-3800

NPI assigned

Jan 11, 2021

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Pediatric Therapy Services Inc

  • Clinic/Center
  • Lakeland, FL
  • NPI 1407834021

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1679162135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1737 TARAH TRACE DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335102065",
            "telephone_number": "941-276-6678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E ORANGE ST",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338015762",
            "telephone_number": "863-802-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDER",
        "first_name": "AMANDA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-11",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "FL",
            "license": "PT36566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whole Steps Creative Arts Center LLC
• Paula Suryani Wibowo, APRN
• Elaine Wickham
• Eric D Wicks, M.D.
• Brett J Widick, MD
• Bethany Wientge
• Maxine Wiggan
• Marwan Wiggins, M.D.
• Sherrel Wiggins
• Gene Martin Wiggs II, DO

• Pediatric Physical Therapist in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Pediatric Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.

Verify at the official NPI Registry.