Provider Demographics
NPI:1528391497
Name:WILTFANG, PERRY GREGG
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:GREGG
Last Name:WILTFANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 REIDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5640
Mailing Address - Country:US
Mailing Address - Phone:864-576-2200
Mailing Address - Fax:864-576-2200
Practice Address - Street 1:2890 REIDVILLE RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5640
Practice Address - Country:US
Practice Address - Phone:864-576-2200
Practice Address - Fax:864-576-2200
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTP-0797237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist