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General NPI Number Information
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NPI Number | 1366374712
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Entity Type | Individual
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Provider Name | DYLAN LEE WILSON PT,DPT
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Gender | Male
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 640 KY-92 SUITE 4
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City | WILLIAMSBURG
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State | KY
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Zip | 40769
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Country | US
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Telephone | 606-539-7257
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Fax | 606-539-7256
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Provider Business Mailing Address
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Address Line | 510 WARD CEMETERY RD
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City | CORBIN
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State | KY
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Zip | 40701-9585
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Country | US
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Telephone | 606-515-8944
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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 | 009548
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License Number State | KY
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