Basic Information
| Provider Information | |||||||||
| NPI: | 1417190224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIMER | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSPT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KAHLER | ||||||||
| OtherFirstName: | ERIN | ||||||||
| OtherMiddleName: | KATHLEEN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSPT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4175 VETERANS MEMORIAL HWY | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | RONKONKOMA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117797639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315805200 | ||||||||
| FaxNumber: | 6315805222 | ||||||||
| Practice Location | |||||||||
| Address1: | 731 LACEY RD | ||||||||
| Address2: | |||||||||
| City: | FORKED RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087311364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092426750 | ||||||||
| FaxNumber: | 6092426783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2009 | ||||||||
| LastUpdateDate: | 05/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01431800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 16859 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.