Provider Demographics
NPI:1982101895
Name:HILTON, WADE ZACHARY (PTA)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:ZACHARY
Last Name:HILTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 E FAIRMOUNT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1516
Mailing Address - Country:US
Mailing Address - Phone:410-878-1954
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE 104
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2108
Practice Address - Country:US
Practice Address - Phone:410-433-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-07
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1106225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant