Individual
TYREESAH LASHAE WILKERSON-COBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5613 MASTER ST, PHILADELPHIA, PA 19131-3833
(215) 820-8073
Mailing address
5613 MASTER ST, PHILADELPHIA, PA 19131-3833
(215) 820-8073
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
807950
PA
Other
Enumeration date
10/31/2022
Last updated
10/31/2022
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