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NPI Code Detail

MEDICARE: MARIANNE WILSON MALE PT

MEDICARE: MARIANNE WILSON MALE 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 Therapist03241OH

General Provider Information

NPI Number : 1720516040
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANNE WILSON MALE PT
Provider Business Mailing Address
First Line : 1122 ROUNDELAY RD E
Second Line :
City : REYNOLDSBURG
State : OH
Zip : 43068-2029
Country : US
Telephone Number : 614-738-5005
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W TOWN ST
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-1379
Country : US
Telephone Number : 614-276-8231
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2017
Last Update Date : 05/31/2017

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