Individual
MR. BRIAN S WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
2350 NW CENTURY DRIVE, SUITE 100, CORVALLIS, OR 97330
(541) 754-1150
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5887
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500606353
—
OR
Enumeration date
03/02/2009
Last updated
12/03/2010
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