Individual
ANNETTA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
640 N EISENHOWER ST, MOSCOW, ID 83843-9588
(208) 882-6560
(208) 882-6569
Mailing address
640 N EISENHOWER ST, MOSCOW, ID 83843-9588
(208) 882-6560
(208) 882-6569
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT-00000493
ID
174400000X
Specialist
PT-80
WA
Other
Enumeration date
01/05/2010
Last updated
01/05/2010
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