Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 21864 | FL |
NPI | 1205058104 |
---|---|
Provider Name | Amy C Wildenstein |
First Address | Tallahassee, FL 32317-7236 |
Second Address | Tallahassee, FL 32308-7709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 30/06/2013 |