Provider Demographics
NPI:1215118948
Name:WILSON PHYSICAL THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:WILSON PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSCOE
Authorized Official - Middle Name:WAYLON
Authorized Official - Last Name:JOYNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:252-338-4099
Mailing Address - Street 1:110 PELICAN POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7764
Mailing Address - Country:US
Mailing Address - Phone:252-338-4099
Mailing Address - Fax:252-338-4096
Practice Address - Street 1:806 W EHRINGHAUS ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6935
Practice Address - Country:US
Practice Address - Phone:252-338-4099
Practice Address - Fax:252-338-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1080261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy