Provider Demographics
NPI:1801636436
Name:WYDER, VICTORIA VILMA NEUBERGER (PT)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:VILMA NEUBERGER
Last Name:WYDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:VILMA
Other - Last Name:NEUBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 BEARS CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477
Mailing Address - Country:US
Mailing Address - Phone:908-296-0655
Mailing Address - Fax:561-626-8940
Practice Address - Street 1:250 BEARS CLUB DRIVE
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477
Practice Address - Country:US
Practice Address - Phone:908-296-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21284225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation