Provider Demographics
NPI:1417190224
Name:WIMER, ERIN KATHLEEN (MSPT, DPT)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:KATHLEEN
Last Name:WIMER
Suffix:
Gender:F
Credentials:MSPT, DPT
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:KATHLEEN
Other - Last Name:KAHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT, DPT
Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:731 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1364
Practice Address - Country:US
Practice Address - Phone:609-242-6750
Practice Address - Fax:609-242-6783
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01431800225100000X
MA168592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic