Provider Demographics
NPI:1386761948
Name:WILSON, MEISHA AIMEE (PT)
Entity type:Individual
Prefix:
First Name:MEISHA
Middle Name:AIMEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15722 IRONSIDE HILL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-3415
Mailing Address - Country:US
Mailing Address - Phone:817-239-5736
Mailing Address - Fax:
Practice Address - Street 1:3040 POST OAK BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6500
Practice Address - Country:US
Practice Address - Phone:713-965-9998
Practice Address - Fax:713-965-9921
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist