Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jeremy Shakouri Wydra

Individual provider Physical Therapist · NPI 1497480792

Jeremy Shakouri Wydra is a Physical Therapist in Private Practice in Winter Garden, Florida. Qualified in 2022, 4 years ago. Practices with The University of Central Florida Board of Trustees, a 43-clinician group and accepts Medicare assignment. Licensed in Florida and Maryland.

Years since qualifying
4
Licensed in
FL, MD
In the registry since
2022
Specialties on file
3

Practice location Address checks out

4040 Winter Garden Vineland Rd
Winter Garden, FL 34787-9502
Phone: (407) 573-3361
Fax: (407) 395-8309
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Orthopedic Physical Therapist (primary) Taxonomy 2251X0800X · Licence PT39007 (FL)
Physical Therapist Taxonomy 225100000X
Physical Therapist Taxonomy 225100000X · Licence 29148 (MD)

Record details

NPI number1497480792
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 20, 2022
Last updated in NPPESJune 7, 2023
Certification dateJune 7, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice The University Of Central Florida Board Of Trustees — 43 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Winter Garden