Healthcare Provider Details

I. General information

NPI: 1235262056
Provider Name (Legal Business Name): MS. SANDRA SLOAN WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 JOG RD STE 100
DELRAY BEACH FL
33446-3808
US

IV. Provider business mailing address

12565 NW 67TH DR
PARKLAND FL
33076-1952
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-5144
  • Fax:
Mailing address:
  • Phone: 954-755-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: