Provider Demographics
NPI:1518539154
Name:WILSON, DAVID KELLEY (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KELLEY
Last Name:WILSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 W HORIZON RIDGE PKWY.,
Mailing Address - Street 2:STE #101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-413-7775
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY.,
Practice Address - Street 2:STE #101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-893-3333
Practice Address - Fax:702-413-7775
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1702161Medicaid