Provider Demographics
NPI:1689645400
Name:WILBERT, JANET MARY (ATC/L)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:MARY
Last Name:WILBERT
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FARMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-6254
Mailing Address - Country:US
Mailing Address - Phone:731-723-9215
Mailing Address - Fax:
Practice Address - Street 1:3006 ELAM CENTER
Practice Address - Street 2:UT MARTIN
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38238-0001
Practice Address - Country:US
Practice Address - Phone:731-881-7339
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT1572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer