Provider Demographics
NPI:1336334325
Name:WILSON, JULIA (PT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
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 1:15000 N DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-3447
Mailing Address - Country:US
Mailing Address - Phone:405-396-4774
Mailing Address - Fax:405-396-4774
Practice Address - Street 1:15000 N DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049-3447
Practice Address - Country:US
Practice Address - Phone:405-396-4774
Practice Address - Fax:405-396-4774
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist