Individual
DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
625 AIDAN DR, SUMTER, SC 29154-6078
(803) 847-2846
Mailing address
625 AIDAN DR, SUMTER, SC 29154-6078
(803) 847-2846
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2606
SC
Other
Enumeration date
10/10/2022
Last updated
10/10/2022
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