Individual
KACEY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2505 N HWY 360 STE 300, GRAND PRAIRIE, TX 75050-6494
(817) 861-7700
(844) 756-4608
Mailing address
1129 ALMOND DR, FORNEY, TX 75126-2686
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
TX
Other
Enumeration date
06/19/2014
Last updated
03/22/2022
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