Individual
PATRICE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
499 AVENUE A, #4, BAYONNE, NJ 07002
(201) 898-3948
Mailing address
499 AVENUE A, #4, BAYONNE, NJ 07002
(201) 898-3948
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00275600
NJ
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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