Doctor Name: | MR. TYLER G WILSON |
NPI Number: | 1831458413 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSPT |
License Number: | 5501015894 |
Business Practice Address: | 2040 N. Aurelius Holt, MI - 488421367 |
Business Phone Number: | 5177836670 |
Business Fax Number: | 5177835310 |
Mailing Address: | 2040 Aurelius Rd, Ste 1 HOLT |
State: | MI |
Postal Code: | 488421367 |
Phone Number: | 5172689040 |
Fax Number: | 5172689042 |
NPI Enumeration Date: | 05/16/2012 |
NPI Last Update Date: | 05/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 5501015894 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
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 |