Individual
MR. JAMIE JOHNSTON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
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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