Provider Demographics
NPI:1396996278
Name:WILTCHER, CAMILA VALERIA FUENTES (DPT)
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:VALERIA FUENTES
Last Name:WILTCHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 DOUBLE TREE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-8915
Mailing Address - Country:US
Mailing Address - Phone:225-241-2469
Mailing Address - Fax:
Practice Address - Street 1:10178 BERRYWOOD CIR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7692
Practice Address - Country:US
Practice Address - Phone:225-241-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA072272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics