Doctor Name: | MS. DEBORA CAROL WILD |
NPI Number: | 1235595372 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 62 009043 |
Business Practice Address: | 55 Melroy Ave Lackawanna, NY - 142181658 |
Business Phone Number: | 7168195036 |
Business Fax Number: | |
Mailing Address: | 59 Frances St, TONAWANDA |
State: | NY |
Postal Code: | 141504016 |
Phone Number: | 7166962008 |
Fax Number: | |
NPI Enumeration Date: | 01/05/2016 |
NPI Last Update Date: | 01/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 62 009043 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |