Individual
MRS. JENNIFER LYNN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1020 S MAIN ST, QUAKERTOWN, PA 18951-1561
(215) 536-9300
Mailing address
465 KLEMAN RD, GILBERTSVILLE, PA 19525-9720
(484) 524-8048
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TEI000189
LICENSE NUMBER
PA
Enumeration date
04/27/2011
Last updated
04/27/2011
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