Individual
DWIGHT E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10737 S MORGAN ST, CHICAGO, IL 60643-3821
(773) 447-8545
Mailing address
10737 S MORGAN ST, CHICAGO, IL 60643-3821
(773) 447-8545
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1600006445
IL
Other
Enumeration date
02/19/2019
Last updated
02/19/2019
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