Individual
JACKIE WILMOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
849 WATERWORKS RD, WINSTON SALEM, NC 27101-1956
(336) 595-2166
Mailing address
100 KERNEY TRL, THURMOND, NC 28683-9571
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4893
NC
Other
Enumeration date
01/28/2013
Last updated
01/28/2013
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