Individual
CHAD J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
7035 W 96TH STREET # D, INDIANAPOLIS, IN 76250-3303
(317) 284-0505
(317) 284-0507
Mailing address
7759 E WASHINGTON ST, INDIANAPOLIS, IN 46219-6742
(317) 359-1215
(317) 359-1235
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008759A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000384246
ANTHEM
IN
Enumeration date
10/24/2006
Last updated
07/08/2007
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