Provider Demographics
NPI:1346056710
Name:WILHELM, JAY MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:MICHAEL
Last Name:WILHELM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 N ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-8655
Mailing Address - Country:US
Mailing Address - Phone:941-460-3831
Mailing Address - Fax:941-218-5627
Practice Address - Street 1:14580 TAMIAMI TRL UNIT D&E
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2708
Practice Address - Country:US
Practice Address - Phone:941-200-2570
Practice Address - Fax:941-218-5627
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT42575OtherDEPARTMENT OF HEALTH