Provider Demographics
NPI:1871723924
Name:WILDERMAN AND ASSOCIATES PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:WILDERMAN AND ASSOCIATES PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WILDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, DPT
Authorized Official - Phone:717-235-1100
Mailing Address - Street 1:73 E FORREST AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1400
Mailing Address - Country:US
Mailing Address - Phone:717-235-1100
Mailing Address - Fax:717-235-1105
Practice Address - Street 1:73 E FORREST AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1400
Practice Address - Country:US
Practice Address - Phone:717-235-1100
Practice Address - Fax:717-235-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006145L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty