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General NPI Number Information
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NPI Number | 1528959673
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Entity Type | Individual
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Provider Name | TIMMIE A WILSON JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 4 PARK CENTER CT
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5611
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Country | US
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Telephone | 410-421-7486
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Fax | 410-377-0576
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Provider Business Mailing Address
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Address Line | 3902 SETONHURST RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-2031
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Country | US
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Telephone | 410-496-9019
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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