| NPI | 1285783613 |
|---|---|
| Former Name | BOBBI ELLEN WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IL 160-004314) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.002090) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-03-01 |