Healthcare Provider Details

I. General information

NPI: 1962531947
Provider Name (Legal Business Name): WILSON THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S ROY ST
DEWITT AR
72042-2992
US

IV. Provider business mailing address

1310 S ROY ST
DEWITT AR
72042-2992
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-3497
  • Fax:
Mailing address:
  • Phone: 870-946-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY CAROLE WILSON
Title or Position: PRESIDENT
Credential: PTA
Phone: 870-946-3497