Healthcare Provider Details

I. General information

NPI: 1235041641
Provider Name (Legal Business Name): MATTHEW T WILSON DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WINDWARD DR STE 110
FISHERSVILLE VA
22939-2174
US

IV. Provider business mailing address

20347 TIMBERLAKE RD STE B
LYNCHBURG VA
24502-7352
US

V. Phone/Fax

Practice location:
  • Phone: 540-949-5383
  • Fax: 540-949-5493
Mailing address:
  • Phone: 540-949-5383
  • Fax: 540-949-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305218072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: