Provider Demographics
NPI:1326313545
Name:WILDER, REBECCA E (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:WILDER
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 1:2835 W DE LEON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-5518
Mailing Address - Country:US
Mailing Address - Phone:813-831-6622
Mailing Address - Fax:813-874-1936
Practice Address - Street 1:2835 W DE LEON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-5518
Practice Address - Country:US
Practice Address - Phone:813-831-6622
Practice Address - Fax:813-874-1936
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 26599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist