Provider Demographics
NPI:1841174703
Name:WILSON, TERENCE
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SOUTH WASHINGTON SQUARE
Mailing Address - Street 2:UNIT 303
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48933
Mailing Address - Country:US
Mailing Address - Phone:517-302-6215
Mailing Address - Fax:
Practice Address - Street 1:3737 BRITTON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9716
Practice Address - Country:US
Practice Address - Phone:517-625-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501016833225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist