Active NPI
Shaena Olivia Wizzard, PT, DPT
- Physical Therapist
- Teaneck, NJ
National Provider Identifier
1730645581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA01846100
- Practice address
- 156 Voorhees St
Teaneck, NJ 07666-6333 - Phone
- (201) 673-2736
- NPI assigned
- Feb 18, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 40QA01846100 | NJ | Primary |
Addresses
Primary practice location
156 Voorhees St
Teaneck, NJ 07666-6333
Mailing address
156 Voorhees St
Teaneck, NJ 07666-6333
Phone (201) 673-2736
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA01846100 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550448000000",
"number": "1730645581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 VOORHEES ST",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076666333",
"telephone_number": "201-673-2736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "156 VOORHEES ST",
"city": "TEANECK",
"state": "NJ",
"postal_code": "076666333",
"telephone_number": "201-673-2736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIZZARD",
"first_name": "SHAENA",
"middle_name": "OLIVIA",
"name_prefix": "Miss",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-18",
"last_updated": "2019-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA01846100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Teaneck, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.