Provider Demographics
NPI:1205388022
Name:WERTZ, HILLARY
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:WERTZ
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 1:345 FARMERS TPKE
Mailing Address - Street 2:
Mailing Address - City:LILLY
Mailing Address - State:PA
Mailing Address - Zip Code:15938-5407
Mailing Address - Country:US
Mailing Address - Phone:814-736-8575
Mailing Address - Fax:
Practice Address - Street 1:345 FARMERS TPKE
Practice Address - Street 2:
Practice Address - City:LILLY
Practice Address - State:PA
Practice Address - Zip Code:15938-5407
Practice Address - Country:US
Practice Address - Phone:814-736-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1280676225100000X
COPTL.0014404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist