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NPI Code Detail

MEDICARE: MRS. KIMBERLY WYATT WILKS PT

MEDICARE: MRS. KIMBERLY WYATT WILKS 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
1225100000XPhysical Therapist6073TN

General Provider Information

NPI Number : 1841376555
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY WYATT WILKS PT
Provider Business Mailing Address
First Line : 2474 MYRACLE TOWN RD
Second Line :
City : DARDEN
State : TN
Zip : 38328-4816
Country : US
Telephone Number : 731-847-7055
Fax Number :
Provider Business Practice Location Address
First Line : 726 KENTUCKY AVE S
Second Line :
City : PARSONS
State : TN
Zip : 38363-3105
Country : US
Telephone Number : 731-847-6371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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