Individual
MIRANDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2316 S EAGLE RD, MERIDIAN, ID 83642-2665
(208) 286-2707
Mailing address
996 E CAYMAN DR, MERIDIAN, ID 83642-6661
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
7420
ID
Other
Enumeration date
06/04/2021
Last updated
06/04/2021
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