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Individual

PATRICK CHARLES WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MPT

Contact information

Practice address
16120 W DODGE RD, OMAHA, NE 68118-2049
(402) 354-0410
(402) 354-0415
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1268
NE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10025895900
NE
05
10025896000
NE
05
10025896100
NE
05
10025941700
NE
05
10026056700
NE
05
10026252200
NE
05
1992081306
IA
Enumeration date
11/21/2005
Last updated
01/02/2014
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