MEDICARE: AMELIA WILSON PT,DPT

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	10526184-2401	UT

General Provider Information

NPI Number	:	1326407024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA WILSON PT,DPT

Provider Business Mailing Address
First Line	:	126 E KELSEY AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-4509
Country	:	US
Telephone Number	:	608-443-8524
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-1103
Country	:	US
Telephone Number	:	801-585-0893
Fax Number	:

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	09/18/2024

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