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General NPI Number Information
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NPI Number | 1497096242
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Entity Type | Individual
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Provider Name | LAUREN MELANIE WILSON
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Gender | Female
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 5535 S WILLIAMSON BLVD STE 774
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City | PORT ORANGE
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State | FL
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Zip | 32128-8311
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Country | US
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Telephone | 800-330-7711
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Fax | 866-426-2811
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Provider Business Mailing Address
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Address Line | 334 HILLSIDE TER
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City | LANDOVER
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State | MD
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Zip | 20785-4700
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Country | US
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Telephone |
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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 | P14087
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License Number State | NC
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