Individual
KEVIN F WILDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA,CSCS
Contact information
Practice address
133 ROSEBURY DR, CANTON, GA 30115-7558
(770) 704-6307
Mailing address
133 ROSEBURY DR, CANTON, GA 30115-7558
(770) 704-6307
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1633
GA
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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