Provider Demographics
NPI:1235149071
Name:WILSON, CHRISTOPHER RYAN (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:WILSON
Suffix:
Gender:M
Credentials:PT
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9149 ESTATE THOMAS
Mailing Address - Street 2:PARAGON MEDICAL BLDG STE 104
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2615
Mailing Address - Country:US
Mailing Address - Phone:340-714-2845
Mailing Address - Fax:340-714-2843
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:PARAGON MEDICAL BLDG STE 104
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2615
Practice Address - Country:US
Practice Address - Phone:340-714-2845
Practice Address - Fax:340-714-2843
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPT008202225100000X
VI144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist