Provider Demographics
NPI:1134259880
Name:WILSON, VERONICA GENIES (PT)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:GENIES
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2036
Mailing Address - Country:US
Mailing Address - Phone:301-408-3638
Mailing Address - Fax:301-946-9164
Practice Address - Street 1:10605 CONCORD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2504
Practice Address - Country:US
Practice Address - Phone:301-929-0688
Practice Address - Fax:301-946-9164
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3242662OtherAETNA HMO
238060OtherMAMSI
5527094OtherAETNA PPO
MD60420001OtherCAREFIRST MARYLAND
DCS4210001OtherCAREFIRST GLOBAL