Individual
CRYSTAL LARAE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 HOSPITAL RD BLDG B, FORT WALTON BEACH, FL 32547-6742
(850) 863-8129
Mailing address
2062 ORTEGA ST, NAVARRE, FL 32566-2178
(386) 984-2350
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA28027
FL
Other
Enumeration date
02/12/2021
Last updated
02/12/2021
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