Active NPI
Alyssa Wilde, PT
- Physical Therapist
- Bridgeton, MO
National Provider Identifier
1932730504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01832
- Practice address
- 11988 Mark Twain LN
Bridgeton, MO 63044-2825 - Phone
- (314) 291-8240
- NPI assigned
- Jan 31, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 01832 | MO | Primary |
Addresses
Primary practice location
11988 Mark Twain LN
Bridgeton, MO 63044-2825
Mailing address
12153 Lake Placid Dr
Saint Louis, MO 63146-5112
Phone (314) 520-1376
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01832 | MO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pelican Sports and Rehabilitation, Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Naples, FL
- NPI 1437173101
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580428800000",
"number": "1932730504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12153 LAKE PLACID DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631465112",
"telephone_number": "314-520-1376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11988 MARK TWAIN LN",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442825",
"telephone_number": "314-291-8240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDE",
"first_name": "ALYSSA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-31",
"last_updated": "2020-01-31",
"certification_date": "2020-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "01832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.