Provider Demographics
NPI:1841416930
Name:WILDER, ROBIN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-3136
Mailing Address - Country:US
Mailing Address - Phone:978-377-0008
Mailing Address - Fax:
Practice Address - Street 1:112 JACKSON ST STE 2
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5045
Practice Address - Country:US
Practice Address - Phone:978-685-5420
Practice Address - Fax:978-685-5768
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist