Basic Information
| Provider Information | |||||||||
| NPI: | 1144349697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILENSKY | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT, MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 PEACHTREE ST NW | ||||||||
| Address2: | SUITE 422 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303092449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047331936 | ||||||||
| FaxNumber: | 4047331940 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 PEACHTREE ST NW | ||||||||
| Address2: | SUITE 422 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303092449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047331936 | ||||||||
| FaxNumber: | 4047331940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8138 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 393730 | 01 | GA | BLUE CROSS BLUE SHIELD | OTHER |