Individual
LEAH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
3942 IVYWOOD LN, PUEBLO, CO 81005-2567
(719) 248-9797
Mailing address
3942 IVYWOOD LN, PUEBLO, CO 81005-2567
(719) 248-9797
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-00105535
CO
Other
Enumeration date
05/25/2013
Last updated
05/25/2013
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