Provider Demographics
NPI:1033120183
Name:WILDS, CHRISTOPHER L (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:L
Last Name:WILDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 W BALTIMORE PIKE
Mailing Address - Street 2:LOBBY LEVEL
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5104
Mailing Address - Country:US
Mailing Address - Phone:610-891-3030
Mailing Address - Fax:610-891-3035
Practice Address - Street 1:1068 W BALTIMORE PIKE
Practice Address - Street 2:LOBBY LEVEL
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5104
Practice Address - Country:US
Practice Address - Phone:610-891-3030
Practice Address - Fax:610-891-3035
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWI1748119OtherPABLUE SHEILD