MEDICARE: JODIE WILSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT540	ME

General Provider Information

NPI Number	:	1114022928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODIE WILSON PT

Provider Business Mailing Address
First Line	:	PO BOX 569
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970-0569
Country	:	US
Telephone Number	:	207-864-3303
Fax Number	:	207-864-2969

Provider Business Practice Location Address
First Line	:	32 RAILROAD STREET
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-1367
Country	:	US
Telephone Number	:	207-824-2193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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Directions to “ JODIE WILSON PT” Practice Location

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