Provider Demographics
NPI:1588353742
Name:WILSON, JONATHAN WESLEY (DPT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:WESLEY
Last Name:WILSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2859
Mailing Address - Country:US
Mailing Address - Phone:814-795-0287
Mailing Address - Fax:
Practice Address - Street 1:11277 VERNON PL
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3717
Practice Address - Country:US
Practice Address - Phone:814-333-5214
Practice Address - Fax:814-333-1482
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist