Individual
ANDRE R WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
209 E BASELINE RD STE E102, TEMPE, AZ 85283-1299
(480) 388-4252
Mailing address
6445 S MAPLE AVE APT 2140, TEMPE, AZ 85283-3643
(480) 388-4252
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-25807
AZ
Other
Enumeration date
06/19/2024
Last updated
06/19/2024
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