Provider Demographics
NPI:1740420868
Name:WILSON, ZAHAVA (MS,PT)
Entity type:Individual
Prefix:MS
First Name:ZAHAVA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12491-5909
Mailing Address - Country:US
Mailing Address - Phone:845-679-5226
Mailing Address - Fax:
Practice Address - Street 1:38 TANGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12491-5909
Practice Address - Country:US
Practice Address - Phone:845-679-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0113592251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics