Individual
MR. EDWARD WORMOLD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
167 MAIN ST, SOUTHAMPTON, NY 11968-4823
(631) 283-4190
(631) 283-7650
Mailing address
18 PALO ALTO DR, HAMPTON BAYS, NY 11946-2811
(631) 283-4190
(631) 283-7650
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
003464-1
NY
Other
Enumeration date
01/23/2006
Last updated
07/08/2007
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