Provider Demographics
NPI:1457661357
Name:WILT, DONALD EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:EDWARD
Last Name:WILT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1027
Mailing Address - Country:US
Mailing Address - Phone:724-654-4457
Mailing Address - Fax:724-654-2909
Practice Address - Street 1:3332 PLANK RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1027
Practice Address - Country:US
Practice Address - Phone:724-654-4457
Practice Address - Fax:724-654-2909
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist