Provider Demographics
NPI:1104473925
Name:WILSON, ARTHUR JAMES IV (PT)
Entity type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:JAMES
Last Name:WILSON
Suffix:IV
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4171 HWY 1 S. STE 10
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767
Mailing Address - Country:US
Mailing Address - Phone:225-416-0333
Mailing Address - Fax:225-416-0332
Practice Address - Street 1:4171 HWY 1 S. STE 10
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767
Practice Address - Country:US
Practice Address - Phone:225-416-0333
Practice Address - Fax:225-416-0332
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist