Individual
COLE JORDAN WILSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
18785 BROOKHURST ST STE 104, FOUNTAIN VALLEY, CA 92708-7300
(657) 301-4967
Mailing address
2437 N PARK BLVD, SANTA ANA, CA 92706-1610
(714) 604-8576
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
51134
CA
Other
Enumeration date
03/22/2021
Last updated
03/22/2021
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