Brooklyn Marie Wildman, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305215015 Issued in VA

Practice address

928 Diamond Springs Rd Ste 103
Virginia Beach, VA 23455-6601

Phone

(757) 395-1975

NPI assigned

Dec 8, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Brooklyn Marie Everman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1790496909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 DIAMOND SPRINGS RD STE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556601",
            "telephone_number": "757-395-1975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 DIAMOND SPRINGS RD STE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556601",
            "telephone_number": "757-395-1975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7419 Granby St",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235053406",
            "country_code": "US",
            "telephone_number": "757-388-9910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDMAN",
        "first_name": "BROOKLYN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-08",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305215015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKLYN",
            "last_name": "EVERMAN",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emma Wild
• Jacob Zachery Wild, RBT
• Rebecca Wild
• Charles D Wilder, MD
• Phyllis Wilder, RN
• Roger P Wiley Jr., M.D.
• Jessica Wilhelm, CSA
• Wendy Lynn Wilkerson, MFP-C
• Angela A Wilkins, PHD
• Steven Rowland Wilkins, O.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.