Provider Demographics
NPI:1316696123
Name:WILT, JANELLE
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:WILT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:CLEAR SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:21722-0254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 N MILL ST
Practice Address - Street 2:
Practice Address - City:CLEAR SPRING
Practice Address - State:MD
Practice Address - Zip Code:21722-1073
Practice Address - Country:US
Practice Address - Phone:717-962-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant