Provider Demographics
NPI:1063298891
Name:WILSON, BRITTANIA THALIA
Entity type:Individual
Prefix:
First Name:BRITTANIA
Middle Name:THALIA
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 TEALWOOD DR APT 104
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4975
Mailing Address - Country:US
Mailing Address - Phone:954-822-9998
Mailing Address - Fax:
Practice Address - Street 1:802 TEALWOOD DR APT 104
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4975
Practice Address - Country:US
Practice Address - Phone:954-822-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33023225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant