Individual
MR. JAMIE JOHNSTON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
HWY 72 WEST, SALEM, MO 65560
(573) 729-6141
Mailing address
13295 COUNTY ROAD 5480, ROLLA, MO 65401-5873
(573) 368-2644
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2007017529
MO
163W00000X
Registered Nurse
—
IL
225200000X
Physical Therapy Assistant
Primary
2007023425
MO
225200000X
Physical Therapy Assistant
—
IL
Other
Enumeration date
04/08/2008
Last updated
04/08/2008
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