Provider Demographics
NPI:1366007502
Name:WILSON, KAREN MCCLAIN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MCCLAIN
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 W COTTON GIN DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-4585
Mailing Address - Country:US
Mailing Address - Phone:984-569-0972
Mailing Address - Fax:
Practice Address - Street 1:1856 W COTTON GIN DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-4585
Practice Address - Country:US
Practice Address - Phone:984-569-0972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011142225100000X
VA2305213168225100000X
DCPT872367225100000X
MD27850225100000X
NCP19612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist