Individual
MATTHEW LAWRENCE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1202 18TH ST, PORTSMOUTH, OH 45662-2922
(740) 727-2060
Mailing address
1202 18TH ST, PORTSMOUTH, OH 45662-2922
(740) 727-2060
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.002822
OH
Other
Enumeration date
02/21/2013
Last updated
02/21/2013
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