Provider Demographics
NPI:1689892952
Name:WILSON PHYSICAL THERAPY. P.A., INC
Entity Type:Organization
Organization Name:WILSON PHYSICAL THERAPY. P.A., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSIOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-781-5681
Mailing Address - Street 1:1989 S. FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3949
Mailing Address - Country:US
Mailing Address - Phone:772-781-5681
Mailing Address - Fax:
Practice Address - Street 1:1989 S. FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3949
Practice Address - Country:US
Practice Address - Phone:772-781-5681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLPT0006232261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1385Medicare PIN