Individual
STACEY LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3022 YORKTOWN CT, LAFAYETTE, IN 47909-3212
(812) 899-2700
Mailing address
3022 YORKTOWN CT, LAFAYETTE, IN 47909-3212
(812) 899-2700
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003530A
IN
Other
Enumeration date
05/05/2017
Last updated
05/05/2017
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