Individual
MR. JON MARK WAHLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
7604 145TH STREET CT E, PUYALLUP, WA 98375-7095
(253) 278-2291
Mailing address
7604 145TH STREET CT E, PUYALLUP, WA 98375-7095
(253) 278-2291
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P160038469
WA
Other
Enumeration date
11/29/2015
Last updated
11/29/2015
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