Provider Demographics
NPI:1568530467
Name:WILSON, AMY TROBAUGH (MSPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:TROBAUGH
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11498 ABBOTS CROSS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-1103
Mailing Address - Country:US
Mailing Address - Phone:804-874-4915
Mailing Address - Fax:
Practice Address - Street 1:9101 MIDLOTHIAN TNPK
Practice Address - Street 2:MAY PT
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-272-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist