Sebastian Wikstrom

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT26000 Issued in FL

Practice address

5535 S Williamson Blvd
Suite 774
Port Orange, FL 32128-8311

Phone

(386) 756-4935

Fax

(386) 944-7202

NPI assigned

Mar 22, 2012

Sex

Male

Sole proprietor

No

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

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hernando Healthcare Associates PAGroup PAC ID 6406844133, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Hernando Healthcare Associates PA

  • Chiropractor
  • Spring Hill, FL
  • NPI 1477753895
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332374400000",
    "number": "1932474061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N SWALLOWTAIL DR",
            "address_2": "APT 201",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321299623",
            "telephone_number": "386-756-4395",
            "fax_number": "386-944-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5535 S WILLIAMSON BLVD",
            "address_2": "SUITE 774",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321288311",
            "telephone_number": "386-756-4935",
            "fax_number": "386-944-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIKSTROM",
        "first_name": "SEBASTIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-22",
        "last_updated": "2012-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT26000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Whelan Lamb
• Donald White, M.D.
• Margaret Whiteside
• Wickshire Port Orange Opco LLC
• Timothy J Wierzbicki, MD
• Jenna Paige Wilcox
• Joey Darren Wilder, D.O.
• Kirsten Reed Wilgers, O.D.
• Breanna Williams
• Bryan Williams

• Physical Therapist in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.