Doctor Name: | MR. JAY DAVID WILSON |
NPI Number: | 1104995604 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT |
License Number: | 938 |
Business Practice Address: | 3101 Broadway N Suite C Fargo, ND - 581021485 |
Business Phone Number: | 7012711000 |
Business Fax Number: | 7015263818 |
Mailing Address: | 827 32nd Ave N, #108 FARGO |
State: | ND |
Postal Code: | 581021087 |
Phone Number: | 7012711000 |
Fax Number: | 7015263818 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 08/07/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 938 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |