Provider Demographics
NPI:1043778806
Name:WILDER, HALEY
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CREST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1664
Mailing Address - Country:US
Mailing Address - Phone:704-674-7904
Mailing Address - Fax:
Practice Address - Street 1:290 N NC 16 BUSINESS HWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8011
Practice Address - Country:US
Practice Address - Phone:704-483-0777
Practice Address - Fax:704-483-1883
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist