Provider Demographics
NPI:1003088667
Name:WILSON ORTHOPEDIC AND SPORTS PT
Entity Type:Organization
Organization Name:WILSON ORTHOPEDIC AND SPORTS PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-300-8400
Mailing Address - Street 1:476 FORTMAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-1870
Mailing Address - Country:US
Mailing Address - Phone:419-300-8400
Mailing Address - Fax:419-300-8401
Practice Address - Street 1:476 FORTMAN DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-1870
Practice Address - Country:US
Practice Address - Phone:419-300-8400
Practice Address - Fax:419-300-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy