Provider Demographics
NPI:1265486773
Name:WILSON, DIONNE (RPT)
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:DIONNE
Other - Middle Name:
Other - Last Name:JEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8805 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2332
Mailing Address - Country:US
Mailing Address - Phone:317-706-7246
Mailing Address - Fax:317-706-7419
Practice Address - Street 1:8805 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2332
Practice Address - Country:US
Practice Address - Phone:317-706-7246
Practice Address - Fax:317-706-7419
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007601A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05007601AOtherLICENSE