Individual
CARL S WILTBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
80 S 13TH WEST, ST. JOHNS, AZ 85936
(928) 337-3020
(928) 337-3979
Mailing address
PO BOX 824, SAINT JOHNS, AZ 85936-0824
(928) 337-3020
(928) 337-3979
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8544
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
443777
—
AZ
Enumeration date
06/29/2009
Last updated
07/11/2014
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