Individual
QUINN WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPM, ATC, LAT
Contact information
Practice address
11130 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1735
(260) 578-0685
Mailing address
5151 E 1300 N, NORTH MANCHESTER, IN 46962-8260
(260) 578-0685
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002122A
IN
Other
Enumeration date
03/02/2016
Last updated
03/02/2016
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