Provider Demographics
NPI:1174566814
Name:WILSON, SANDRA H (PT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:H
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:88 STATE ROUTE 37
Mailing Address - Street 2:UNIT 2
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-5036
Mailing Address - Country:US
Mailing Address - Phone:203-313-3923
Mailing Address - Fax:203-312-0699
Practice Address - Street 1:88 STATE ROUTE 37
Practice Address - Street 2:UNIT 2
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-5036
Practice Address - Country:US
Practice Address - Phone:203-313-3923
Practice Address - Fax:203-312-0699
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT003001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist