NPI | 1871022103 |
---|---|
Entity Type | Organization |
Authorized Contact | DAVID WILDERMAN Owner/President 302-691-9055 |
Organization Subpart ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0002854) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-006145L) |
225100000X Physical Therapist (Licence: PA DAPT002107) | |
Enumeration Date | 2017-06-09 |
Last Update Date | 2022-07-21 |