Healthcare Provider Details

I. General information

NPI: 1972420420
Provider Name (Legal Business Name): ALEX WILSON LE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 DESCANSO AVE
SAN MARCOS CA
92078-2514
US

IV. Provider business mailing address

1454 VISTA HEIGHTS WAY UNIT 108
VISTA CA
92084-7293
US

V. Phone/Fax

Practice location:
  • Phone: 760-280-2230
  • Fax:
Mailing address:
  • Phone: 408-646-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: