Individual
PAUL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2005 ELM ST STE 200, FOREST GROVE, OR 97116-2781
(503) 357-9810
(503) 357-9819
Mailing address
16083 SW UPPER BOONES FERRY RD STE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
62298
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500725396
—
OR
01
—
R194490
MEDICARE
OR
01
—
R195362
MEDICARE
OR
Enumeration date
05/24/2017
Last updated
07/27/2017
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