Provider Demographics
NPI:1912440595
Name:WILDAY, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WILDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HIGHWAY ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:SHARON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13459-2004
Mailing Address - Country:US
Mailing Address - Phone:518-284-2013
Mailing Address - Fax:
Practice Address - Street 1:128 HIGHWAY ROUTE 20
Practice Address - Street 2:
Practice Address - City:SHARON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13459-2004
Practice Address - Country:US
Practice Address - Phone:518-284-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist