Provider Demographics
NPI:1609272087
Name:WILTSIE, JUSTINE MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MARIE
Last Name:WILTSIE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FREEDOMWAY
Mailing Address - Street 2:APT. #306
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-6401
Mailing Address - Country:US
Mailing Address - Phone:607-287-2710
Mailing Address - Fax:
Practice Address - Street 1:135 COUNTY RD
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2203
Practice Address - Country:US
Practice Address - Phone:201-569-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist