| Organization Name: | WILDWOOD PHYSICAL THERAPY INC |
| NPI Number: | 1952300782 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAMELA ANDREA LEDUC (VICE PRESIDENT) |
| Mailing Address: | 11392 Pleasant Valley Rd Penn Valley |
| State: | CA US |
| Postal Code: | 959469001 |
| Phone Number: | 5304329660 |
| Fax Number: | 5304329663 |
| NPI Enumeration Date: | 07/14/2005 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |