| Doctor Name: | LISA WILDS |
| NPI Number: | 1134120116 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT,OCS,CERT.MDT,COMT |
| License Number: | PT009484-L |
| Business Practice Address: | 420 Bainbridge St Philadelphia, PA - 191471568 |
| Business Phone Number: | 2156291270 |
| Business Fax Number: | 2156295531 |
| Mailing Address: | 235 Harwicke Rd, SPRINGFIELD |
| State: | PA |
| Postal Code: | 190643101 |
| Phone Number: | 6105431493 |
| Fax Number: | 2156291293 |
| NPI Enumeration Date: | 08/02/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | PT009484-L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |