Steven R Wilde, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

23052140442 Issued in VA

Practice address

6970 Fox Hunt LN
Gloucester, VA 23061-5394

Phone

(804) 694-8111

Fax

(804) 694-5574

NPI assigned

Jun 20, 2006

Last updated

Dec 31, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Steven R Wilde Ms LPT

  • Physical Therapist
  • Greensburg, PA
  • NPI 1629028113
  NPD (past) Authorized official

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1710923776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 PELLLIS RD",
            "city": "GREENSBURG",
            "state": "PA",
            "postal_code": "156014599",
            "telephone_number": "724-832-1696",
            "fax_number": "724-832-6351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6970 FOX HUNT LN",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230615394",
            "telephone_number": "804-694-8111",
            "fax_number": "804-694-5574"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "518 Pelllis Rd",
            "address_purpose": "LOCATION",
            "city": "Greensburg",
            "state": "PA",
            "postal_code": "156014599",
            "country_code": "US",
            "telephone_number": "724-832-1696",
            "fax_number": "724-832-6351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDE",
        "first_name": "STEVEN",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "23052140442",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT003818L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "000424032",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "4625101",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rodney Levi Willoughby, BA-CSAC-QMHP

• Physical Therapist in Gloucester, VA
• Providers in Gloucester, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; 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.