Annetta Wilson, P.T.

NPI #1891025482 in Moscow, Idaho

Provider Information

NPI Number: 1891025482
Entity Type: Individual
Name: Annetta Wilson, P.T.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: P.T.
Enumeration Date: Jan 5, 2010
Last Updated: Jan 5, 2010

Practice Location

Address: 640 N EISENHOWER ST
City: Moscow
State: Idaho
ZIP Code: 83843-9588
Phone: (208) 882-6560

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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