Provider Demographics
NPI:1649504358
Name:WILSON, BARBARA JOAN (MSPT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 BETHMOUR RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3370
Mailing Address - Country:US
Mailing Address - Phone:203-393-1136
Mailing Address - Fax:203-393-1136
Practice Address - Street 1:479 BETHMOUR RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:CT
Practice Address - Zip Code:06524-3370
Practice Address - Country:US
Practice Address - Phone:203-393-1136
Practice Address - Fax:203-393-1136
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist