| NPI | 1457694739 |
|---|---|
| Former Name | AMY DIANE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 10146A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2095570) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2013-05-14 |