Provider Demographics
NPI:1093442881
Name:WILSON, SAMUEL GEORGE (DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GEORGE
Last Name:WILSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3801 GANNON LN APT 3314
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3038
Mailing Address - Country:US
Mailing Address - Phone:859-539-1098
Mailing Address - Fax:
Practice Address - Street 1:1121 FLOWER MOUND RD STE 540
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3251
Practice Address - Country:US
Practice Address - Phone:972-355-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist