Provider Demographics
NPI:1164509212
Name:WILT, ANNE REBECCA (MPT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:REBECCA
Last Name:WILT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 FAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4060
Mailing Address - Country:US
Mailing Address - Phone:304-225-5222
Mailing Address - Fax:304-225-5224
Practice Address - Street 1:746 FAIRMONT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-4060
Practice Address - Country:US
Practice Address - Phone:304-225-5222
Practice Address - Fax:304-225-5224
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9335681OtherMEDICARE GROUP
WV9335681OtherMEDICARE GROUP