Healthcare Provider Details

I. General information

NPI: 1821156167
Provider Name (Legal Business Name): BRIAN JAMES WILKINSON D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WILLAMETTE STREET STE 302
EUGENE OR
97401
US

IV. Provider business mailing address

1711 WILLAMETTE STREET STE 302
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-4536
  • Fax: 541-653-9669
Mailing address:
  • Phone: 541-357-4536
  • Fax: 541-653-9669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33173
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05883
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: