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Individual

MARY ANNE WILDMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSPT

Contact information

Practice address
5 SAINT VINCENT CIR STE 100, LITTLE ROCK, AR 72205-5415
(501) 663-6455
(501) 978-1473
Mailing address
5 SAINT VINCENT CIR STE 100, LITTLE ROCK, AR 72205-5415
(501) 663-6455
(501) 978-1473

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2010
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
183722721
AR
Enumeration date
09/07/2010
Last updated
10/21/2010
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