Individual
MR. JUSTIN STEVEN WILHELM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1025 BULLARD CT # 105, RALEIGH, NC 27615-6801
(919) 875-1932
(919) 875-1933
Mailing address
10408 COKESBURY LN, RALEIGH, NC 27614-6719
(704) 933-9509
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10240
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56-2280143
PROVIDER TAX ID
NC
Enumeration date
07/16/2006
Last updated
08/05/2010
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