Individual
JAY WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
200 N 7TH AVE, STURGEON BAY, WI 54235-1708
(920) 743-5274
Mailing address
3364 S WILLOW RD, STURGEON BAY, WI 54235-8695
(712) 635-5230
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1940-19
WI
Other
Enumeration date
05/15/2013
Last updated
05/15/2013
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