JEREMY SHAKOURI WYDRA
NPI 1497480792
Physical Therapist - Orthopedic in Winter Garden, FL

Q: What is Jeremy Wydra's NPI number?

The NPI number for Jeremy Wydra is 1497480792. It was assigned to this individual provider in the NPPES registry on July 20, 2022.

Q: What is Jeremy Wydra's specialty?

The primary specialty registered for this NPI is Physical Therapist, specializing in Orthopedic, with taxonomy code 2251X0800X.

Q: When was this NPI record last updated?

The NPPES record for Jeremy Wydra was last updated on June 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 20, 2022Accepts Medicare Assignment

4040 WINTER GARDEN VINELAND RD, WINTER GARDEN, FL 34787(407) 573-3361(407) 395-8309 Get Directions Write a Review

NPPES record last updated: June 7, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 7, 2023, Feb 7, 2023, Jul 20, 2022 (3 updates tracked since 2022).

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About Jeremy Shakouri Wydra NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEREMY SHAKOURI WYDRA (NPI 1497480792) is an individual orthopedic provider in Winter Garden, Florida, licensed in Florida (PT39007) and active in the NPI registry since July 2022. He is a graduate of Other (2022).

NPPES Registry Identity

NPI1497480792

Entity TypeIndividualMale

Primary Taxonomy2251X0800X

Provider Legal NameJEREMY SHAKOURI WYDRA

Location Address4040 WINTER GARDEN VINELAND RDWinter Garden, FL 34787-9502

Mailing Address4040 Winter Garden Vineland RdWinter Garden, FL 34787-9502 · (407) 573-3361 · Fax (407) 395-8309

Phone(407) 573-3361

Fax(407) 395-8309

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateJuly 20, 2022

Last NPPES UpdateJune 7, 20233 updates tracked since enumeration

NPPES CertifiedJune 7, 2023

✔ NPI 1497480792 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysical Therapist · OrthopedicRespiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy Code2251X0800X

License✔ Licensed in FL · PT39007

Definition

A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopaedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science; pathology/pathophysiology, pain science, medical and surgical considerations, orthopaedic physical therapy theory and practice, and critical inquiry for evidence-based practice.

Also ListedPhysical TherapistTaxonomy 225100000X · License 29148 (MD)

4040 WINTER GARDEN VINELAND RD, Winter Garden, FL 34787

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jeremy Shakouri Wydra is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9931585957

PECOS Enrollment IDI20230630003218

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. JULI LYNN WILLIAMS PT

Physical Therapist