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NPI Code Detail

MEDICARE: AMY WILSON P.T.

MEDICARE: AMY WILSON P.T.
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 Therapist1126027TX

General Provider Information

NPI Number : 1972834794
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY WILSON P.T.
Provider Business Mailing Address
First Line : 5521 VILLAGE CREEK DR
Second Line :
City : PLANO
State : TX
Zip : 75093-4829
Country : US
Telephone Number : 972-447-0038
Fax Number : 972-447-0441
Provider Business Practice Location Address
First Line : 5521 VILLAGE CREEK DR
Second Line :
City : PLANO
State : TX
Zip : 75093-4829
Country : US
Telephone Number : 972-447-0038
Fax Number : 972-447-0441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2010
Last Update Date : 01/18/2010

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