Individual
ANNELIESE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
238 N UNIVERSITY AVE APT 16, PROVO, UT 84601-2821
(801) 373-3484
Mailing address
710 W 800 N, PROVO, UT 84601-1518
(808) 206-2158
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
10378
HI
225700000X
Massage Therapist
Primary
6149567-4701
UT
Other
Enumeration date
08/31/2009
Last updated
11/22/2020
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