Individual
MR. JOHN LEONARD WILSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5405 BABCOCK ST NE, PALM BAY, FL 32905-5020
(321) 722-9801
Mailing address
260 FALLS CHURCH ST SW, PALM BAY, FL 32908-7115
(609) 685-0586
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA22760
FL
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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