Individual
MARY C WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8540 SCARBOROUGH DR STE 200, COLORADO SPRINGS, CO 80920-7513
(719) 630-7500
Mailing address
29315 WILKERSON VW, CALHAN, CO 80808-9055
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
12728
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12728
MEDICARE
CO
Enumeration date
09/05/2013
Last updated
09/05/2013
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