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General NPI Number Information
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NPI Number | 1972249415
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Entity Type | Organization
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Legal Business Name | WILDER PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 53 DARBY RD STE E
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City | PAOLI
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State | PA
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Zip | 19301-1480
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Country | US
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Telephone | 610-981-1698
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 CHURCH RD
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City | ORELAND
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State | PA
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Zip | 19075-2303
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Country | US
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Telephone | 610-564-6968
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | ELIZABETH MICHEL
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Credential | PT, DPT
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Telephone | 610-981-1698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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