Individual
TARA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1333 MEADOWLARK LN, STE 104, KANSAS CITY, KS 66102-1260
(913) 287-9303
Mailing address
21311 W 51ST ST, SHAWNEE, KS 66218-9089
(913) 271-3833
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-01634
LICENSE#
KS
Enumeration date
08/30/2006
Last updated
07/08/2007
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