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General NPI Number Information
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NPI Number | 1174521868
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Entity Type | Individual
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Provider Name | THOMAS CHRISTOPHER WILSON PT
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 3455 HIGHWAY 81 SOUTH
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City | LOGANVILLE
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State | GA
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Zip | 30052-3918
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Country | US
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Telephone | 678-635-8280
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Fax | 678-635-8285
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Provider Business Mailing Address
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Address Line | 3455 HIGHWAY 81 SOUTH
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City | LOGANVILLE
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State | GA
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Zip | 30052-3918
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Country | US
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Telephone | 678-635-8280
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Fax | 678-635-8285
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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 | 15262
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT008470
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License Number State | GA
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