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NPI Code Detail

MEDICARE: DONNA LYNN WILSON LPTA

MEDICARE: DONNA LYNN WILSON LPTA
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
1225200000XPhysical Therapy AssistantA00933KY

General Provider Information

NPI Number : 1700314457
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA LYNN WILSON LPTA
Provider Business Mailing Address
First Line : PO BOX 714
Second Line :
City : MORGANTOWN
State : KY
Zip : 42261-0714
Country : US
Telephone Number : 270-999-1764
Fax Number :
Provider Business Practice Location Address
First Line : 813 S MAIN ST
Second Line :
City : BROWNSVILLE
State : KY
Zip : 42210-9009
Country : US
Telephone Number : 270-597-2335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2017
Last Update Date : 05/25/2017

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