Individual
MR. JESSE T WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
816 BROAD ST, SUITE 17, MERIDEN, CT 06450-4350
(203) 238-1334
Mailing address
33 OLD FIELD HILL RD, SOUTHBURY, CT 06488-3836
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000119
CT
Other
Enumeration date
03/25/2007
Last updated
03/10/2015
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