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General NPI Number Information
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NPI Number | 1861491185
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Entity Type | Individual
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Provider Name | LAURA CHRISTINE WILSON DPT
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Gender | Female
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 1450 E PRATER WAY SUITE 103
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City | SPARKS
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State | NV
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Zip | 89434-8972
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Country | US
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Telephone | 775-331-1199
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Fax | 775-331-1180
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Provider Business Mailing Address
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Address Line | 1450 E PRATER WAY SUITE 103
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City | SPARKS
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State | NV
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Zip | 89434-8972
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Country | US
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Telephone | 775-331-1199
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Fax | 775-331-1180
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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 | 6741
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1707
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License Number State | NV
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