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General NPI Number Information
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NPI Number | 1881764785
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Entity Type | Individual
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Provider Name | RAE WILSON PT
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 97 DOVER ST STE 200
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City | AVON
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State | IN
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Zip | 46123-7356
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Country | US
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Telephone | 317-272-1954
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Fax |
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Provider Business Mailing Address
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Address Line | 732 PLANTERS RIDGE DR
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City | COLLIERVILLE
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State | TN
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Zip | 38017-6181
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Country | US
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Telephone | 317-345-8263
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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 | PT0000010223
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License Number State | TN
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