Basic Information
| Provider Information | |||||||||
| NPI: | 1619278892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILD | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T., D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 EDWARDS MILL RD | ||||||||
| Address2: | 200 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276125243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197814060 | ||||||||
| FaxNumber: | 9197815246 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 SUMNER BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276166675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198761100 | ||||||||
| FaxNumber: | 9198761186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2010 | ||||||||
| LastUpdateDate: | 09/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P13698 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 033230-1 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.