Individual
DR. JONATHAN B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, DPT
Contact information
Practice address
625 19TH ST S, BIRMINGHAM, AL 35233-1900
(205) 934-6957
Mailing address
625 19TH ST S, BIRMINGHAM, AL 35233-1900
(205) 934-6957
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PTH7703
AL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13765704
CAQH
AL
01
—
511-68556
BCBS OF AL
AL
01
—
511-68569
BCBS OF AL
AL
01
—
P01586197
MEDICARE RR
AL
Enumeration date
08/18/2015
Last updated
05/04/2025
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