Individual
REGINA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
514 GERHARD ST, PHILADELPHIA, PA 19128-1632
(215) 756-3534
Mailing address
514 GERHARD ST, PHILADELPHIA, PA 19128-1632
(215) 756-3534
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/08/2021
Last updated
05/20/2024
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