Provider Demographics
NPI:1982311973
Name:WILSON, KATELYN ELISE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:ELISE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 NORMANDY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1942
Mailing Address - Country:US
Mailing Address - Phone:901-288-8987
Mailing Address - Fax:
Practice Address - Street 1:342 N MAIN ST STE 129
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8376
Practice Address - Country:US
Practice Address - Phone:901-288-8987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist