Provider Demographics
NPI:1265655013
Name:WILBERT & ASSOCIATES PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WILBERT & ASSOCIATES PHYSICAL THERAPY
Other - Org Name:KEITH WILBERT, PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:860-225-0674
Mailing Address - Street 1:195 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1318
Mailing Address - Country:US
Mailing Address - Phone:860-225-0674
Mailing Address - Fax:860-223-3330
Practice Address - Street 1:195 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1318
Practice Address - Country:US
Practice Address - Phone:860-225-0674
Practice Address - Fax:860-223-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002360261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080002360CT02OtherANTHEM BLUE CROSS
CT080002360CT02OtherANTHEM BLUE CROSS