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General NPI Number Information
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NPI Number | 1043916588
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Entity Type | Individual
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Provider Name | ANNIE MACAINE WILSON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 27100 CEDAR RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-1109
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Country | US
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Telephone | 216-831-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 731 NEWPORT LN APT 202
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City | STREETSBORO
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State | OH
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Zip | 44241-4015
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Country | US
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Telephone | 330-569-4158
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 020250
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License Number State | OH
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