Provider Demographics
NPI:1073289393
Name:WILBERT, GWENDOLYN ANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:ANNE
Last Name:WILBERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1432
Mailing Address - Country:US
Mailing Address - Phone:978-501-6323
Mailing Address - Fax:
Practice Address - Street 1:18 PORTER RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1432
Practice Address - Country:US
Practice Address - Phone:978-501-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist