| Doctor Name: | THEO WILSON |
| NPI Number: | 1164851895 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 008444 |
| Business Practice Address: | 16 Avery Hts Hartford, CT - 061064201 |
| Business Phone Number: | 3474904333 |
| Business Fax Number: | |
| Mailing Address: | 16 Avery Hts, HARTFORD |
| State: | CT |
| Postal Code: | 061064201 |
| Phone Number: | 3474904333 |
| Fax Number: | |
| NPI Enumeration Date: | 11/04/2013 |
| NPI Last Update Date: | 11/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 008444 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| 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 |