Individual
CARRIE JO WILES
Active
Individual
CARRIE JO WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-003277
KY
2251S0007X
Sports Physical Therapist
PT-003277
KY
2251X0800X
Orthopedic Physical Therapist
PT-003277
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB5773
RR MEDICARE GRP
GA
01
—
P00029197
RR MEDICARE PIN
GA
Enumeration date
11/14/2006
Last updated
11/02/2007
Update your record
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