NPIMap

Organization Active NPI

Wilderman Physical Therapy, LLC

  • Physical Therapist
  • Wilmington, DE
National Provider Identifier
1871022103
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
J1-0002854 Issued in DE
Legal business name
WILDERMAN PHYSICAL THERAPY, LLC
Practice address
2626 Belaire Dr
Wilmington, DE 19808-3835
Phone
(302) 691-9055
Fax
(302) 444-8440
NPI assigned
Jun 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. David Wilderman, PT, DPT, MSNPI 1730147232
Title
Owner/President
Phone
(302) 691-9055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X J1-0002854 DE Primary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT-006145L PA
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X DAPT002107 PA

Addresses

Primary practice location

2626 Belaire Dr
Wilmington, DE 19808-3835

Mailing address

2626 Belaire Dr
Wilmington, DE 19808-3835
Phone (302) 691-9055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170811000078 DE Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6406127398 Receives reassigned benefits from 1 practitioner
Practice locations: Wilmington, DE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1871022103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 BELAIRE DR",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198083835",
            "telephone_number": "302-691-9055",
            "fax_number": "302-444-8440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 BELAIRE DR",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198083835",
            "telephone_number": "302-691-9055",
            "fax_number": "302-444-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERMAN PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-09",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WILDERMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "302-691-9055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, MS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "DE",
            "license": "J1-0002854",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT-006145L",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "DAPT002107",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.