Individual
BRANDY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3300 RIVERMONT AVE, LYNCHBURG, VA 24503-2030
(434) 200-4668
(434) 200-3003
Mailing address
44 CLIFTON ST, LYNCHBURG, VA 24501-1422
(434) 528-1848
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305203967
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010118646
—
VA
05
—
010118751
—
VA
Enumeration date
08/05/2006
Last updated
12/27/2015
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