Kevin F Wildes, LPTA,CSCS

NPI #1912241357 in Canton, Georgia

Provider Information

NPI Number: 1912241357
Entity Type: Individual
Name: Kevin F Wildes, LPTA,CSCS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Credential: LPTA,CSCS
Enumeration Date: Nov 26, 2012
Last Updated: Nov 26, 2012

Practice Location

Address: 133 ROSEBURY DR
City: Canton
State: Georgia
ZIP Code: 30115-7558
Phone: (770) 704-6307

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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