Provider Demographics
NPI:1881229979
Name:WILSON, CHRISTINE (PT 05272)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT 05272
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 OAK POINT RD.
Mailing Address - Street 2:LORAIN
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053
Mailing Address - Country:US
Mailing Address - Phone:440-233-1070
Mailing Address - Fax:440-233-1056
Practice Address - Street 1:5940 OAK POINT RD.
Practice Address - Street 2:LORAIN
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-233-1070
Practice Address - Fax:440-233-1056
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist