| 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 |