Provider Demographics
NPI:1477112571
Name:WILSON WELLNESS
Entity Type:Organization
Organization Name:WILSON WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-312-7740
Mailing Address - Street 1:1 COMMUNITY ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5201
Mailing Address - Country:US
Mailing Address - Phone:304-242-3933
Mailing Address - Fax:304-242-3833
Practice Address - Street 1:1 COMMUNITY ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5201
Practice Address - Country:US
Practice Address - Phone:304-242-3933
Practice Address - Fax:304-242-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty