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General NPI Number Information
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NPI Number | 1255772265
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Entity Type | Individual
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Provider Name | WILCIA ARISTILDE PTA
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 875 ROUTE 202/206
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-1861
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Country | US
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Telephone | 561-506-9719
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Fax |
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Provider Business Mailing Address
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Address Line | 875 ROUTE 202/206
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-1861
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Country | US
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Telephone | 561-506-9719
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00288300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA20220
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License Number State | FL
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