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General NPI Number Information
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NPI Number | 1992310098
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Entity Type | Individual
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Provider Name | JESSICA LYNNE WILD PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 436 AMHERST ST STE 102
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City | NASHUA
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State | NH
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Zip | 03063-1276
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Country | US
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Telephone | 603-417-5087
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Fax | 603-417-5089
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Provider Business Mailing Address
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Address Line | 436 AMHERST ST STE 102
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City | NASHUA
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State | NH
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Zip | 03063-1276
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Country | US
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Telephone | 603-417-5087
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Fax | 603-417-5089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4717
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT5764
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 25987
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License Number State | MA
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