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General NPI Number Information
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NPI Number | 1295792315
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Entity Type | Individual
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Provider Name | REBEL FLYNN WILSON P.T.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5912 CYPRESS CREEK DR
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City | N LITTLE ROCK
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State | AR
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Zip | 72116-6355
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Country | US
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Telephone | 501-771-2005
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Fax | 501-771-2005
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Provider Business Mailing Address
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Address Line | 710 FOXWOOD DR
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City | JACKSONVILLE
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State | AR
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Zip | 72076-2642
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Country | US
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Telephone | 501-985-0118
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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 | PT 2506
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License Number State | AR
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