Provider Demographics
NPI:1366686123
Name:WILEY, PAULA V (LMT)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:V
Last Name:WILEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8980 N US HIGHWAY 1
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-7515
Mailing Address - Country:US
Mailing Address - Phone:772-589-5772
Mailing Address - Fax:
Practice Address - Street 1:8980 N US HIGHWAY 1
Practice Address - Street 2:UNIT 1
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-7515
Practice Address - Country:US
Practice Address - Phone:772-589-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23811225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist