Provider Demographics
NPI:1194941963
Name:WILTSHIRE, OPEL LADALE (PTA)
Entity type:Individual
Prefix:
First Name:OPEL
Middle Name:LADALE
Last Name:WILTSHIRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 N MCCAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-3039
Mailing Address - Country:US
Mailing Address - Phone:361-332-8171
Mailing Address - Fax:
Practice Address - Street 1:3823 46TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1207
Practice Address - Country:US
Practice Address - Phone:361-332-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant