Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1235720921 |
---|---|
Provider Name | Savanah Wilt |
First Address | Broomall, PA 19008-3654 |
Second Address | Broomall, PA 19008-3654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2021 |
Last Update Date | 20/08/2021 |