Individual
ENEIDA B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5300 CHESTER AVE, PHILADELPHIA, PA 19143-4929
(215) 727-0411
Mailing address
5300 CHESTER AVE, PHILADELPHIA, PA 19143-4929
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT024535
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N/A
N/A
—
Enumeration date
10/14/2015
Last updated
02/07/2019
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