MEDICARE: KAREEM 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
2	225100000X	Physical Therapist	303507	CA

General Provider Information

NPI Number	:	1689394371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREEM WILSON PT

Provider Business Mailing Address
First Line	:	324 N 19TH ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-1858
Country	:	US
Telephone Number	:	347-571-3974
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 FREMONT AVE
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-5617
Country	:	US
Telephone Number	:	347-571-3974
Fax Number	:

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

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	05/09/2024

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Directions to “ KAREEM WILSON PT” Practice Location

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