Individual
MR. KEVIN DAVID WILSON
Active
Individual
MR. KEVIN DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT010461
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000385602
ANTHEM
OH
05
—
2638622
—
OH
01
—
9416961
PHCS
OH
01
—
P00421513
MEDICARE RAILROAD
OH
Enumeration date
02/15/2006
Last updated
09/10/2019
Update your record
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