| NPI | 1861579757 |
|---|---|
| Former Name | JESSICA MARIE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011720A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070015349) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-05-20 |