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NPI Code Detail

MEDICARE: MR. THOMAS CHRISTOPHER WILSON PT

MEDICARE: MR. THOMAS CHRISTOPHER 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
1225100000XPhysical Therapist15262FL
2225100000XPhysical TherapistPT008470GA

General Provider Information

NPI Number : 1174521868
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS CHRISTOPHER WILSON PT
Provider Business Mailing Address
First Line : 3455 HIGHWAY 81 SOUTH
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-3918
Country : US
Telephone Number : 678-635-8280
Fax Number : 678-635-8285
Provider Business Practice Location Address
First Line : 3455 HIGHWAY 81 SOUTH
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-3918
Country : US
Telephone Number : 678-635-8280
Fax Number : 678-635-8285
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 11/10/2015

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