Provider Demographics
NPI:1205058104
Name:WILDENSTEIN, AMY C (MS PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:WILDENSTEIN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:LUVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PT
Mailing Address - Street 1:224 MYDDELTON TRCE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7236
Mailing Address - Country:US
Mailing Address - Phone:941-465-8906
Mailing Address - Fax:
Practice Address - Street 1:1725 HERMITAGE BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7709
Practice Address - Country:US
Practice Address - Phone:850-325-6301
Practice Address - Fax:850-325-6302
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL218642251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology