NPI | 1992362867 |
---|---|
Former Name | COURTNEY WILSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MS PTA6230) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR CP000109A) |
Enumeration Date | 2019-05-24 |
Last Update Date | 2019-05-24 |