Individual
TINA A. WILSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
555 E MARKET ST, ELMIRA, NY 14901-3223
(607) 733-6541
Mailing address
2997 KELLEYTOWN RD, MANSFIELD, PA 16933-9631
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
003969-1
NY
225200000X
Physical Therapy Assistant
TE002707L
PA
Other
Enumeration date
01/03/2007
Last updated
07/08/2007
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