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NPI Code Detail

MEDICARE: KATHRYN G WILSON PT

MEDICARE:   KATHRYN G 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 TherapistPT001704GA

General Provider Information

NPI Number : 1780648717
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN G WILSON PT
Provider Business Mailing Address
First Line : 2616 WARM SPRINGS RD
Second Line : SUITE B
City : COLUMBUS
State : GA
Zip : 31904-5642
Country : US
Telephone Number : 706-243-0016
Fax Number : 706-243-0019
Provider Business Practice Location Address
First Line : 2616 WARM SPRINGS RD
Second Line : SUITE B
City : COLUMBUS
State : GA
Zip : 31904-5642
Country : US
Telephone Number : 706-243-0016
Fax Number : 706-243-0019
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 07/08/2007

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