Provider Demographics
NPI:1861640815
Name:WILBERT, TIMOTHY (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WILBERT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1603
Mailing Address - Country:US
Mailing Address - Phone:585-442-6067
Mailing Address - Fax:585-442-6073
Practice Address - Street 1:539 LONG POND RD
Practice Address - Street 2:STE 2
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3073
Practice Address - Country:US
Practice Address - Phone:585-227-2310
Practice Address - Fax:585-227-2312
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist