Provider Demographics
NPI:1578545661
Name:WILTON, CHANTAL SIGOUIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:SIGOUIN
Last Name:WILTON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25411 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5055
Mailing Address - Country:US
Mailing Address - Phone:315-782-0002
Mailing Address - Fax:315-883-1333
Practice Address - Street 1:26515 NYS RT 3
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1749
Practice Address - Country:US
Practice Address - Phone:315-408-6023
Practice Address - Fax:315-782-0002
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0941Medicare PIN
NYJ400001050Medicare PIN