Jack Anthony Wilder PT

NPI 1326269739 - Physical Therapist - 2251X0800X

NPI Details
NPI 1326269739
Gender Male
Enumeration Date 05/01/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
405 BLACK HILLS LN SW
SUITE G
OLYMPIA WA, 98502-8661, US
Phone (360) 956-2562
Fax (360) 956-1894
Business Location
4701 77TH CT SE
OLYMPIA WA, 98501-9697, US
Phone (360) 455-9068
Fax
Toxanomy
Taxonomy Code 2251X0800X
License State Washington
License Number PT00009619
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According to our database, Mr. Jack Anthony Wilder PT NPI is 1326269739, taxonomy code is 2251X0800X and license number is PT00009619, license state is located at Washington. Jack Anthony Wilder PT physically located at 405 Black Hills Ln Sw, Olympia WA, 98502-8661. NPI Number Jack Anthony Wilder PT has the Individual type.

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1326269739 NPI number is provided on an as is basis without warranty of any kind. 1326269739 is maintained by the National Plan & Provider Enumeration System. The contents of Jack Anthony Wilder PT are for informational purposes only.