Provider Demographics
NPI:1518078138
Name:WILSON, MEGAN MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 POINT TO POINT RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6153
Mailing Address - Country:US
Mailing Address - Phone:443-512-0845
Mailing Address - Fax:
Practice Address - Street 1:101 WALTER WARD BLVD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1210
Practice Address - Country:US
Practice Address - Phone:443-409-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist