Individual
LYLE KEITH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MMQ
Contact information
Practice address
1073 PIONEER MOUNTAIN LOOP, TOLEDO, OR 97391-9780
(214) 546-4427
Mailing address
1073 PIONEER MOUNTAIN LOOP, TOLEDO, OR 97391-9780
(214) 546-4427
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
11/11/2024
Last updated
11/11/2024
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