Individual
BRANDY MIKEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
PO BOX 634, EVERSON, WA 98247-0634
(360) 966-4810
Mailing address
3000 ORLEANS ST # 102, BELLINGHAM, WA 98226-3542
(907) 713-4259
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P161515318
WA
Other
Enumeration date
06/26/2024
Last updated
02/01/2025
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