Individual
TIFFANY RACHELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1000 ASSOCIATION DR, CHARLESTON, WV 25311-1270
(304) 347-4372
Mailing address
735 CANTERBURY DR, CHARLESTON, WV 25314-1772
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 001563
WV
Other
Enumeration date
02/13/2013
Last updated
02/13/2013
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