Individual
MARCUS BRANT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12200 HIGHWAY 43, RUSSELLVILLE, AL 35653-4737
(866) 537-5614
Mailing address
240 ROBERTS DR, FLORENCE, AL 35634-2634
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH3093
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTH3093
PHYSICAL THERAPY LICENSE
AL
Enumeration date
12/31/2006
Last updated
07/08/2007
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