Healthcare Provider Details

I. General information

NPI: 1689892952
Provider Name (Legal Business Name): WILSON PHYSICAL THERAPY. P.A., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 S. FEDERAL HIGHWAY SUITE 203
STUART FL
34994-3949
US

IV. Provider business mailing address

1989 S. FEDERAL HIGHWAY SUITE 203
STUART FL
34994-3949
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-5681
  • Fax:
Mailing address:
  • Phone: 772-781-5681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberFLPT0006232
License Number StateFL

VIII. Authorized Official

Name: MR. DWIGHT E WILSON
Title or Position: OWNER/PHYSIOTHERAPIST
Credential:
Phone: 772-781-5681