Individual
MS. KIMBERLY EVONNE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1005 SPRINGWOOD CT, VIRGINIA BEACH, VA 23455-6692
(405) 314-6564
Mailing address
1005 SPRINGWOOD CT, VIRGINIA BEACH, VA 23455-6692
(405) 314-6564
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306602685
VA
Other
Enumeration date
06/25/2009
Last updated
06/25/2009
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