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NPI Code Detail

MEDICARE: AMY C WILDENSTEIN MS PT

MEDICARE: AMY C WILDENSTEIN MS PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251N0400XNeurology Physical Therapist21864FL

General Provider Information

NPI Number : 1205058104
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY C WILDENSTEIN MS PT
Provider Business Mailing Address
First Line : 224 MYDDELTON TRCE
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32317-7236
Country : US
Telephone Number : 941-465-8906
Fax Number :
Provider Business Practice Location Address
First Line : 1725 HERMITAGE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-7709
Country : US
Telephone Number : 850-325-6301
Fax Number : 850-325-6302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 06/30/2013

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