Individual
TONYA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
15822 CLAYTON RD, ELLISVILLE, MO 63011-2212
(636) 220-1681
Mailing address
246 WESTRIDGE PARC LN, ELLISVILLE, MO 63021-4207
(636) 236-9577
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116424
MO
310400000X
Assisted Living Facility
311679605
MO
Other
Enumeration date
09/22/2015
Last updated
09/22/2015
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