Individual
MRS. SHANNON LEANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-6059
(503) 215-6394
Mailing address
2719 NE 94TH ST, VANCOUVER, WA 98665-9589
(316) 304-1784
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5187
OR
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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