Basic Information
Provider Information
NPI: 1770055246
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILSON
FirstName: APRIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1200 CORPORATE DR STE 400
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352425424
CountryCode: US
TelephoneNumber: 4236828840
FaxNumber: 4236022028
Practice Location
Address1: 610 N FAYETTEVILLE ST STE 201
Address2:  
City: ASHEBORO
State: NC
PostalCode: 272034671
CountryCode: US
TelephoneNumber: 3366334263
FaxNumber: 3366334267
Other Information
ProviderEnumerationDate: 12/21/2018
LastUpdateDate: 12/21/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000XA2679NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


Home