Healthcare Provider Details

I. General information

NPI: 1245328780
Provider Name (Legal Business Name): ALICIA BETH WILSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 GENESEE ST
AUBURN NY
13021-3231
US

IV. Provider business mailing address

278 GENESEE ST
AUBURN NY
13021
US

V. Phone/Fax

Practice location:
  • Phone: 315-282-0067
  • Fax: 315-282-0587
Mailing address:
  • Phone: 315-282-0067
  • Fax: 315-282-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: