Healthcare Provider Details

I. General information

NPI: 1558320473
Provider Name (Legal Business Name): DEL WILSON PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E FEDERAL STREET
MIDDLEBURG VA
20117
US

IV. Provider business mailing address

PO BOX 893
MIDDLEBURG VA
20118
US

V. Phone/Fax

Practice location:
  • Phone: 540-687-6565
  • Fax: 540-687-6585
Mailing address:
  • Phone: 540-687-6565
  • Fax: 540-687-6585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LOUIS D WILSON
Title or Position: OWNER PRESIDENT
Credential: PT
Phone: 540-687-6565