Provider Demographics
NPI:1083263172
Name:WILSON, ASHLEY LYNN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LYNN
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 1:3038 N FEDERAL HWY STE C
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1436
Mailing Address - Country:US
Mailing Address - Phone:954-856-4630
Mailing Address - Fax:
Practice Address - Street 1:3038 N FEDERAL HWY STE C
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1436
Practice Address - Country:US
Practice Address - Phone:954-856-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34838261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy