Individual
MS. HALLE L. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT, OCS
Contact information
Practice address
1795 HIGH ST SE, SALEM, OR 97302-5156
(503) 930-4653
Mailing address
1795 HIGH ST SE, SALEM, OR 97302-5156
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4822
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0210754
WA DEPT OF L & I
WA
05
—
278293
—
OR
01
—
500746101
REGENCE HMO
OR
01
—
838969001
REGENCE BCBS
OR
01
—
M103634
PACIFIC SOURCE HEALTH PLA
OR
Enumeration date
11/08/2006
Last updated
02/05/2014
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