Individual
WILSON LANE TEN PAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
727 SE MAIN ST STE 200, SIMPSONVILLE, SC 29681-3262
(864) 999-3831
(864) 794-5411
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
SC
Other
Enumeration date
02/09/2024
Last updated
02/20/2024
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