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General NPI Number Information
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NPI Number | 1902429160
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Entity Type | Individual
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Provider Name | JESSICA L WILSON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/22/2020
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 4329 S PEORIA AVE STE 320
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City | TULSA
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State | OK
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Zip | 74105-3936
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Country | US
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Telephone | 918-794-9000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 721018
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City | NORMAN
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State | OK
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Zip | 73070-4786
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Country | US
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Telephone | 405-809-8713
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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 | 5825
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License Number State | OK
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