Healthcare Provider Details

I. General information

NPI: 1003747122
Provider Name (Legal Business Name): D'ASYA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HALIFAX ST
WILLIAMSTON NC
27892-1816
US

IV. Provider business mailing address

209 HALIFAX ST
WILLIAMSTON NC
27892-1816
US

V. Phone/Fax

Practice location:
  • Phone: 252-217-7159
  • Fax:
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: