Organization
WILSON PHYSICAL THERAPY & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER BRADLEY WILSON P.T., A.T.C. (PRESIDENT-OWNER)
(931) 381-8444
Entity
Organization
Contact information
Practice address
1412 TROTWOOD AVE, SUITE 14, COLUMBIA, TN 38401-4968
(931) 381-8444
Mailing address
1412 TROTWOOD AVE, SUITE 14, COLUMBIA, TN 38401-4968
(931) 381-8444
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
1648
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003144510
BLUE CROSS BLUE SHIELD
TN
01
—
0446647
TENNCARE
TN
Enumeration date
02/01/2007
Last updated
08/22/2013
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