Individual
MR. JOHN WILSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPRS
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
000-1216
TN
225700000X
Massage Therapist
MA47923
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C4119
BLUE CROSS PROVIDER
FL
Enumeration date
12/13/2006
Last updated
07/02/2021
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