Provider Demographics
NPI:1932506292
Name:WILSON, CHASITY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E SKAGGS CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-9422
Mailing Address - Country:US
Mailing Address - Phone:812-560-9915
Mailing Address - Fax:
Practice Address - Street 1:850 E SKAGGS CT
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-9422
Practice Address - Country:US
Practice Address - Phone:812-560-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002269A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer