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General NPI Number Information
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NPI Number | 1407994692
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Entity Type | Organization
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Legal Business Name | WILSON PHYSICAL THERAPY & WELLNESS
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 1412 TROTWOOD AVE SUITE 14
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City | COLUMBIA
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State | TN
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Zip | 38401-4968
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Country | US
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Telephone | 931-381-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 TROTWOOD AVE SUITE 14
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City | COLUMBIA
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State | TN
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Zip | 38401-4968
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Country | US
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Telephone | 931-381-8444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | WALTER BRADLEY WILSON
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Credential | P.T., A.T.C.
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Telephone | 931-381-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1648
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License Number State | TN
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