MEDICARE: MRS. VERONICA GENIES WILSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	15391	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3242662	OTHER		AETNA HMO
2	238060	OTHER		MAMSI
3	5527094	OTHER		AETNA PPO
4	60420001	OTHER	MD	CAREFIRST MARYLAND
5	S4210001	OTHER	DC	CAREFIRST GLOBAL

General Provider Information

NPI Number	:	1134259880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERONICA GENIES WILSON PT

Provider Business Mailing Address
First Line	:	2208 HAMPSHIRE DR
Second Line	:
City	:	ADELPHI
State	:	MD
Zip	:	20783-2036
Country	:	US
Telephone Number	:	301-408-3638
Fax Number	:	301-946-9164

Provider Business Practice Location Address
First Line	:	10605 CONCORD ST
Second Line	:	SUITE 201
City	:	KENSINGTON
State	:	MD
Zip	:	20895-2504
Country	:	US
Telephone Number	:	301-929-0688
Fax Number	:	301-946-9164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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