Individual
PATTY RAELENE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
301 N MAIN ST STE 301, PUEBLO, CO 81003-3259
(719) 671-4317
Mailing address
2271 OLETTA LN, PUEBLO, CO 81006-1648
(719) 671-4317
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT.0013933
CO
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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