Provider Demographics
NPI:1528082112
Name:WILSON, JULIA ANN (MPT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5227
Mailing Address - Country:US
Mailing Address - Phone:804-562-8323
Mailing Address - Fax:
Practice Address - Street 1:8201 ATLEE RD
Practice Address - Street 2:SUITE D
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1815
Practice Address - Country:US
Practice Address - Phone:804-569-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist