Individual
MR. KEVIN DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2835 MIAMI VILLAGE DR, MIAMISBURG, OH 45342-4587
(937) 449-0796
(937) 262-7468
Mailing address
6480 HARRISON AVE STE 201, CINCINNATI, OH 45247-7961
(513) 354-3700
(513) 354-7651
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
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