Individual
MS. DIANE R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2103 REEDALE AVE, AUGUSTA, GA 30906-3430
(706) 814-6887
(706) 814-6587
Mailing address
2103 REEDALE AVE, AUGUSTA, GA 30906-3430
(706) 814-6887
(706) 814-6587
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002911
GA
Other
Enumeration date
01/05/2011
Last updated
07/18/2011
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