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Individual

DEANNA MAXINE WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
4277 STERLING AVE, RAYTOWN, MO 64133-1351
(816) 353-0060
(816) 358-5830
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-4915
(423) 238-7217
(423) 238-7217

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
14-03496
KS
225200000X
Physical Therapy Assistant
Primary
2019010827
MO

Other

Enumeration date
03/14/2019
Last updated
10/04/2019
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