Individual
ANDREW MICHAEL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3585 BRAMBLETON AVE, ROANOKE, VA 24018-6521
(540) 776-1029
Mailing address
2518 EDINBURGH DR NW, ROANOKE, VA 24012-2110
(540) 354-8530
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306603680
VA
Other
Enumeration date
08/07/2013
Last updated
08/07/2013
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