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NPI Code Detail

MEDICARE: MRS. LOURDES RAQUEL WILKERSON PT

MEDICARE: MRS. LOURDES RAQUEL WILKERSON PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251G0304XGeriatric Physical Therapist1085033TX

General Provider Information

NPI Number : 1356823991
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LOURDES RAQUEL WILKERSON PT
Provider Business Mailing Address
First Line : 1448 HOUSTON ST
Second Line :
City : WILLS POINT
State : TX
Zip : 75169-3120
Country : US
Telephone Number : 903-873-5400
Fax Number :
Provider Business Practice Location Address
First Line : 1448 HOUSTON ST
Second Line :
City : WILLS POINT
State : TX
Zip : 75169-3120
Country : US
Telephone Number : 903-873-2728
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2018
Last Update Date : 08/30/2018

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