Provider Demographics
NPI:1265658652
Name:WILSON, RONALD KEITH (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:KEITH
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5922
Mailing Address - Country:US
Mailing Address - Phone:772-299-3383
Mailing Address - Fax:772-299-3367
Practice Address - Street 1:1060 6TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5922
Practice Address - Country:US
Practice Address - Phone:772-299-3383
Practice Address - Fax:772-299-3367
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist