Healthcare Provider Details

I. General information

NPI: 1326336595
Provider Name (Legal Business Name): CATHERINE ELIZABETH WILSON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE WILSON

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KEEWAYDIN DR
SALEM NH
03079-2839
US

IV. Provider business mailing address

5001 STATESMAN DR
IRVING TX
75063-2414
US

V. Phone/Fax

Practice location:
  • Phone: 800-995-2673
  • Fax: 866-420-1055
Mailing address:
  • Phone: 877-282-5613
  • Fax: 877-508-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number618
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: