Provider Demographics
NPI:1285633750
Name:WILSON, JULIA B (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:B
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 S HARVARD AVE
Mailing Address - Street 2:#111
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2631
Mailing Address - Country:US
Mailing Address - Phone:918-712-7868
Mailing Address - Fax:918-749-2901
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:#111
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2631
Practice Address - Country:US
Practice Address - Phone:918-712-7868
Practice Address - Fax:918-749-2901
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4812251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100663220EMedicaid
OK10228OtherBLUE CROSS BLUE SHILED
OK100663220CMedicaid
OK21824112OtherAETNA
OK200046900BMedicaid
OK4199540OtherAETNA
OK4199540OtherAETNA
OK100663220CMedicaid