| 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 |