Individual
ADAM WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
133 N MAIN ST, WILKES BARRE, PA 18702
(904) 738-9469
Mailing address
208 13TH ST, BELMONT, NC 28012
(704) 517-1008
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/10/2017
Last updated
09/10/2017
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