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NPI Code Detail

MEDICARE: STEVEN WILSON PT

MEDICARE: STEVEN 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
1225100000XPhysical TherapistLPT-007014AZ

General Provider Information

NPI Number : 1598377939
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN WILSON PT
Provider Business Mailing Address
First Line : 56540 MCFALL PL
Second Line :
City : HANNIBAL
State : MO
Zip : 63401-7788
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6020 BROADWAY ST
Second Line :
City : QUINCY
State : IL
Zip : 62305-7919
Country : US
Telephone Number : 217-224-3366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2020
Last Update Date : 08/18/2020

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