Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 225100000X | Physical Therapist | PT-6573 | ID |
N | 2251P0200X | Physical Therapist - Pediatrics | 1191421 | TX |
NPI | 1083004873 |
---|---|
Provider Name | Ashleigh Wilson |
First Address | Boise, ID 83716-6865 |
Second Address | Boise, ID 83716-6865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2015 |
Last Update Date | 26/12/2019 |