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General NPI Number Information
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NPI Number | 1295883486
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Entity Type | Individual
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Provider Name | ANN M WILBERT MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 01/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5006 VETERANS MEMORIAL HWY
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City | HOLBROOK
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State | NY
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Zip | 11741-4514
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Country | US
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Telephone | 631-567-3815
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Fax |
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Provider Business Mailing Address
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Address Line | 865 BROADWAY AVE APT 197A
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City | HOLBROOK
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State | NY
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Zip | 11741-4945
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Country | US
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Telephone | 631-567-3815
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 005985
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License Number State | NY
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