Provider Demographics
NPI:1558541599
Name:WILSON, CAROLINE RENEE (DPT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:RENEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 S TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3426
Mailing Address - Country:US
Mailing Address - Phone:714-633-7227
Mailing Address - Fax:714-633-6092
Practice Address - Street 1:871 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3426
Practice Address - Country:US
Practice Address - Phone:714-633-7227
Practice Address - Fax:714-633-6092
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist