Individual
MARY W WILDERMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
9250 A HIGHWAY 17 BYPASS, MURRELLS INLET, SC 29576-9326
(843) 215-8787
(843) 215-8670
Mailing address
9250 A HIGHWAY 17 BYPASS, MURRELLS INLET, SC 29576-9326
(843) 215-8787
(843) 215-8670
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1703
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH0328
—
SC
Enumeration date
05/17/2006
Last updated
10/09/2007
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