Individual
KATIE LYNN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
100 E FERGUSON ST STE 1204, TYLER, TX 75702-5700
(903) 509-2040
Mailing address
100 E FERGUSON ST STE 1204, TYLER, TX 75702-5700
(903) 509-2040
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1232246
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972980779
—
TX
Enumeration date
04/30/2015
Last updated
03/04/2018
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