Provider Demographics
NPI:1609892629
Name:WILSTIN THERAPY, INC.
Entity Type:Organization
Organization Name:WILSTIN THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PERAGINE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:718-344-2185
Mailing Address - Street 1:5851 HOLMBERG RD
Mailing Address - Street 2:APARTMENT #926
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4536
Mailing Address - Country:US
Mailing Address - Phone:718-344-2185
Mailing Address - Fax:954-755-8726
Practice Address - Street 1:5851 HOLMBERG RD
Practice Address - Street 2:APARTMENT #926
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4536
Practice Address - Country:US
Practice Address - Phone:718-344-2185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty