Individual
RAE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
97 DOVER ST STE 200, AVON, IN 46123-7356
(317) 272-1954
Mailing address
732 PLANTERS RIDGE DR, COLLIERVILLE, TN 38017-6181
(317) 345-8263
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0000010223
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05007942A
LICENSE#
IN
Enumeration date
11/08/2006
Last updated
04/24/2024
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