Individual
RYAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2708 NE 14TH ST APT 5, POMPANO BEACH, FL 33062-3564
(888) 880-9270
Mailing address
819 18TH ST, NEWPORT NEWS, VA 23607-5809
(757) 273-4879
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
01/11/2012
Last updated
01/11/2012
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