Jennifer Waidelich, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305211035 Issued in VA

Practice address

410 E Ave
Coronado, CA 92118

Phone

(609) 658-9191

NPI assigned

Sep 18, 2017

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• JW Physical Therapy

  • Physical Therapy Clinic/Center
  • Coronado, CA
  • NPI 1376035642
  NPD Authorized official
• Vim LLC

  • Physical Therapist
  • Virginia Beach, VA
  • NPI 1083480651
  NPD (past)

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1962921395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2228 WINDY PINES BND",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234563930",
            "telephone_number": "609-658-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E AVE",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "92118",
            "telephone_number": "609-658-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAIDELICH",
        "first_name": "JENNIFER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-18",
        "last_updated": "2022-07-21",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305211035",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "293722",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Villegas, ACAGNP-BC
• Vipeak PC (Peak Health Group)
• Wagner Drug Corporation (Central Drug)
• Elizabeth Wagner, RD, CCN
• Luke Andrew Wagner, SOIDC
• Walgreen Co (Walgreens #13859)
• William M Wansa, MD
• Kenneth Warm, M.D.
• David E. Warren, D.D.S.
• Hilori Wastila, RN

• Physical Therapist in Coronado, CA
• Providers in Coronado, CA by specialty
• Physical Therapist in California

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.