Individual
MR. JOHN DAVID WILD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
510 W PINE ST, PONCHATOULA, LA 70454-3738
(985) 634-1966
Mailing address
510 W PINE ST, PONCHATOULA, LA 70454-3738
(985) 634-1966
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
08568
LA
Other
Enumeration date
05/21/2015
Last updated
05/21/2015
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