Individual
DR. TANNER BRYCE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
703 E MAIN ST UNIT 1, LEBANON, KY 40033-8696
(270) 699-9503
Mailing address
145 HEART LN, CAMPBELLSVILLE, KY 42718-7376
(270) 670-2823
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
008824
KY
Other
Enumeration date
08/21/2023
Last updated
08/21/2023
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