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RICHARD MAX WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
310 DURAN DR, SHELBYVILLE, IN 46176-1986
(317) 421-0244
(317) 421-0245
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05003667A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000112015
ANTHEM ID
IN
05
200146190
IN
Enumeration date
04/04/2006
Last updated
08/02/2016
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