Provider Demographics
NPI:1043842297
Name:WILSON, MARINA ADEL (DPT)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:ADEL
Last Name:WILSON
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:ABOUELZEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:3241 S CUSTER RD STE 101
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1622
Practice Address - Country:US
Practice Address - Phone:972-979-6577
Practice Address - Fax:972-979-6951
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045414-01225100000X
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist