Individual
MR. JACK ANTHONY WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
405 BLACK HILLS LN SW, SUITE G, OLYMPIA, WA 98502-8661
(360) 956-2562
(360) 956-1894
Mailing address
4701 77TH CT SE, OLYMPIA, WA 98501-9697
(360) 455-9068
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT00009619
WA
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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