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General NPI Number Information
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NPI Number | 1972315976
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Entity Type | Organization
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Legal Business Name | MARIA WILSON, PT, LLC
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Dates
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Enumeration Date | 01/25/2025
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 653 ZINNIA WAY
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City | TEGA CAY
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State | SC
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Zip | 29708-0185
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Country | US
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Telephone | 864-205-8260
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Fax |
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Provider Business Mailing Address
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Address Line | 653 ZINNIA WAY
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City | TEGA CAY
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State | SC
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Zip | 29708-0185
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Country | US
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Telephone | 864-205-8260
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MARIA WILSON
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Credential | PT
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Telephone | 864-205-8260
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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 |
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License Number State |
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