Jolyna Wilson, MSPT
Individual provider Active NPI Physical Therapist · Lakeside, MT
NPI 1417535808 · NPPES record last updated Mar 29, 2021
Key facts
- NPI
- 1417535808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 19503 (MT)
- Practice address
- 366 Lakeshore Dr
Lakeside, MT 59922-9712 - Phone
- (303) 475-2504
- NPI assigned
- Mar 29, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19503 | MT | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 19503 | MT | Yes |
Addresses
Primary practice location
366 Lakeshore Dr
Lakeside, MT 59922-9712
Mailing address
366 Lakeshore Dr
Lakeside, MT 59922-9712
Phone (303) 475-2504
Other providers in Lakeside, MT
All providers in Lakeside, MT · Physical Therapist in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.