MEDICARE: CHARLES A 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	P11345	NC

General Provider Information

NPI Number	:	1598953184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES A WILSON PT

Provider Business Mailing Address
First Line	:	90 E MAIN ST STE A
Second Line	:
City	:	SYLVA
State	:	NC
Zip	:	28779-3030
Country	:	US
Telephone Number	:	828-550-3923
Fax Number	:	828-354-0209

Provider Business Practice Location Address
First Line	:	90 E MAIN ST STE A
Second Line	:
City	:	SYLVA
State	:	NC
Zip	:	28779-3030
Country	:	US
Telephone Number	:	828-550-3923
Fax Number	:	828-354-0209

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	04/27/2022

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Directions to “ CHARLES A WILSON PT” Practice Location

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