Individual
MR. BRYAN ADAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
515 MAIN ST, OLEAN, NY 14760-1513
(716) 375-7481
Mailing address
401 LAURENS ST APT D, OLEAN, NY 14760-2575
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
007318
NY
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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