Provider Demographics
NPI:1730147232
Name:WILDERMAN, DAVID ANTHONY (PT DPT MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:WILDERMAN
Suffix:
Gender:M
Credentials:PT DPT MS
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Mailing Address - Street 1:1 CENTURIAN DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2137
Mailing Address - Country:US
Mailing Address - Phone:302-633-5787
Mailing Address - Fax:302-633-5781
Practice Address - Street 1:1 CENTURIAN DR
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2137
Practice Address - Country:US
Practice Address - Phone:302-633-5787
Practice Address - Fax:302-633-5781
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT006145L225100000X
DEJ1-0002854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00716Medicare PIN
DE272523ZBSXMedicare PIN