Provider Demographics
NPI:1841423829
Name:WILSON, CHARLES LYNN (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9317 N CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:VA
Mailing Address - Zip Code:22844-9508
Mailing Address - Country:US
Mailing Address - Phone:540-740-8841
Mailing Address - Fax:540-740-8841
Practice Address - Street 1:315 E LEE HWY
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:VA
Practice Address - Zip Code:22844-3103
Practice Address - Country:US
Practice Address - Phone:540-740-8041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist