Individual
JENNIFER ANNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 S HILTON ST, BOISE, ID 83705-1925
(208) 345-4464
(208) 433-5398
Mailing address
1017 N 20TH ST, BOISE, ID 83702-3208
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1539
ID
Other
Enumeration date
07/22/2008
Last updated
07/22/2008
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