Individual
MS. SI-RON M WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1001 N GRANT ST, LEBANON, IN 46052-1944
(765) 482-6400
Mailing address
2268 WYNBROOKE BLVD, INDIANAPOLIS, IN 46234-7654
(812) 910-0192
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003742A
IN
Other
Enumeration date
12/15/2008
Last updated
12/15/2008
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