Provider Demographics
NPI:1427494970
Name:WILSON, JENNIFER ANN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:COLLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:8215 MILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2213
Mailing Address - Country:US
Mailing Address - Phone:513-407-8227
Mailing Address - Fax:
Practice Address - Street 1:6281 TRI RIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8345
Practice Address - Country:US
Practice Address - Phone:866-791-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist