Individual
MARTHA L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4750
Mailing address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 430-4750
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4857
WI
225100000X
Physical Therapist
5501018168
MI
Other
Enumeration date
12/07/2005
Last updated
12/11/2020
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