Individual
MARY C. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1205 YORK RD, 19, LUTHERVILLE TIMONIUM, MD 21093-6210
(410) 296-9195
(410) 296-9197
Mailing address
1205 YORK RD, 19, LUTHERVILLE TIMONIUM, MD 21093-6210
(410) 296-9195
(410) 296-9197
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15035
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35184405
BLUE CROSS BLUE SHIELD
MD
01
—
DA2862 P00046856
RAILROAD MEDICARE
MD
01
—
S9550001
BCBS FEDERAL
MD
Enumeration date
02/22/2007
Last updated
07/13/2012
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