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General NPI Number Information
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NPI Number | 1720161094
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Entity Type | Individual
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Provider Name | MRS. JEAN K WILSON
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9720 SW 162ND ST
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City | MIAMI
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State | FL
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Zip | 33157-3318
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Country | US
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Telephone | 305-253-3391
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Fax | 305-251-7490
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Provider Business Mailing Address
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Address Line | 9720 SW 162ND ST
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City | MIAMI
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State | FL
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Zip | 33157-3318
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Country | US
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Telephone | 305-253-3391
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Fax | 305-251-7490
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 003426
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License Number State | FL
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