Provider Demographics
NPI:1962531947
Name:WILSON THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:WILSON THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CAROLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:870-946-3497
Mailing Address - Street 1:1310 S ROY ST
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-2992
Mailing Address - Country:US
Mailing Address - Phone:870-946-3497
Mailing Address - Fax:
Practice Address - Street 1:1310 S ROY ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2992
Practice Address - Country:US
Practice Address - Phone:870-946-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty