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Individual
WILSON PARK
Active
Individual
WILSON PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305215239
VA
225100000X
Physical Therapist
CP015186T
MD
Other
Enumeration date
06/15/2021
Last updated
03/15/2024
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