Individual
MICHAEL JOHN WILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, PES
Contact information
Practice address
4380 MAIN ST, AMHERST, NY 14226-3544
(716) 839-8581
(716) 566-7858
Mailing address
5963 ROUTE 98, PO BOX 7, GREAT VALLEY, NY 14741-0007
(716) 969-7581
(716) 566-7858
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
7952261
NY
Other
Enumeration date
06/10/2014
Last updated
06/10/2014
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