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Contact Information

LESLIE D WILSON, PT
3451 GOODMAN RD E STE 108
SOUTHAVEN, MS38672-9305
 Phone: 662-890-6953
 Fax: 662-890-6954
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
 

Orthopedic

2251X0800X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for LESLIE D WILSON · (Female)

NPI # 1639424799
Status Active
Credentials PT (Physical Therapist)
Entity Individual
Enumeration date 07/16/2012
Last updated 03/25/2025 - More than a year ago
Sole proprietor 1 No
Identifiers
  • MS License # PT5223
  • OH License # PT017702
  • OH Medicaid 0317629
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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