MEDICARE: JULIA MOONEY WILSON

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	2305216438	VA

General Provider Information

NPI Number	:	1861228181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA MOONEY WILSON

Provider Business Mailing Address
First Line	:	1944 CENTERVILLE TPKE STE 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6839
Country	:	US
Telephone Number	:	757-271-4585
Fax Number	:	833-627-5148

Provider Business Practice Location Address
First Line	:	5660 INDIAN RIVER RD STE 121
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5240
Country	:	US
Telephone Number	:	757-252-5300
Fax Number	:

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

Provider Enumeration Date	:	09/12/2024
Last Update Date	:	10/29/2024

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Directions to “ JULIA MOONEY WILSON ” Practice Location

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