Provider Demographics
NPI:1144349697
Name:WILENSKY, HALEY (PT, MPT)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:
Last Name:WILENSKY
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 422
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2449
Mailing Address - Country:US
Mailing Address - Phone:404-733-1936
Mailing Address - Fax:404-733-1940
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 422
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:404-733-1936
Practice Address - Fax:404-733-1940
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA393730OtherBLUE CROSS BLUE SHIELD
GA65BBFGFMedicare PIN