Individual
MR. FREDERICK CHARLES WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT ATC
Contact information
Practice address
18905 E 33RD STREET CT S, INDEPENDENCE, MO 64057-3336
(816) 589-0100
Mailing address
18905 E 33RD STREET CT S, INDEPENDENCE, MO 64057-3336
(816) 795-6118
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
107962
MO
2255A2300X
Athletic Trainer
Primary
00156
MO
Other
Enumeration date
03/17/2006
Last updated
09/11/2025
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