Doctor Name: | MRS. VICKY RENNAE WILSON |
NPI Number: | 1548210701 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 921 |
Business Practice Address: | 101 N 2nd St Raton, NM - 877403803 |
Business Phone Number: | 5054457090 |
Business Fax Number: | |
Mailing Address: | Hc 63 Box 715, 201 Trail Canyon Road RATON |
State: | NM |
Postal Code: | 877409712 |
Phone Number: | 5054459465 |
Fax Number: | |
NPI Enumeration Date: | 05/10/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 921 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
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 |