Individual
JEANNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4451 NELSON RD, LAKE CHARLES, LA 70605-4136
(337) 564-5027
(337) 564-5028
Mailing address
PO BOX 849, JENNINGS, LA 70546-0849
(337) 824-8287
(337) 824-8290
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A6802
LA
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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