Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 21268 | FL |
NPI | 1003070582 |
---|---|
Provider Name | Michelle Erica Wilson |
First Address | Ocoee, FL 34761-6918 |
Second Address | Ocoee, FL 34761-6918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2008 |
Last Update Date | 15/07/2008 |