Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 030205-1 | NY |
N | 225100000X | Physical Therapist | 070016725 | IL |
NPI | 1003048448 |
---|---|
Provider Name | Wilbert Lao |
First Address | Ridgewood, NY 11385-5839 |
Second Address | New York, NY 10010-1006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2009 |
Last Update Date | 19/08/2009 |