Healthcare Provider Details

I. General information

NPI: 1841716891
Provider Name (Legal Business Name): KATHERINE CLAIRE WILCOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 KEMPSVILLE CIR STE 200B
NORFOLK VA
23502-3945
US

IV. Provider business mailing address

230 CLEARFIELD AVE STE 124
VA BEACH VA
23462-1832
US

V. Phone/Fax

Practice location:
  • Phone: 757-321-3384
  • Fax: 757-455-5598
Mailing address:
  • Phone: 757-321-3300
  • Fax: 757-321-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number293512
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216343
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: