Individual
LORA LINN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8000 N COUNTY ROAD 600 W, GASTON, IN 47342-9339
(765) 358-3851
Mailing address
8000 N COUNTY ROAD 600 W, GASTON, IN 47342-9339
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06001901A
IN
Other
Enumeration date
06/24/2010
Last updated
06/24/2010
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