Individual
STEVEN CARL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
8404 W 13TH ST N, BLDG D,#180, WICHITA, KS 67212-2978
(316) 773-6327
(316) 773-6285
Mailing address
24310 W 109TH TER, OLATHE, KS 66061-8852
(913) 706-0362
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-00936
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100417090A
—
KS
01
—
481243012
OTHER MANAGED CARE PLANS
KS
Enumeration date
03/04/2007
Last updated
06/19/2019
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