Provider Demographics
NPI:1821015868
Name:WILHELM, JUSTIN STEVEN (PT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:STEVEN
Last Name:WILHELM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10408 COKESBURY LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6719
Mailing Address - Country:US
Mailing Address - Phone:704-933-9509
Mailing Address - Fax:
Practice Address - Street 1:1025 BULLARD CT # 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6801
Practice Address - Country:US
Practice Address - Phone:919-875-1932
Practice Address - Fax:919-875-1933
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56-2280143OtherPROVIDER TAX ID