Healthcare Provider Details

I. General information

NPI: 1245279967
Provider Name (Legal Business Name): COLLEEN ANN WILKENS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 UNDERWOOD AVE
WAUWATOSA WI
53213-2619
US

IV. Provider business mailing address

10590 N PORT WASHINGTON RD
MEQUON WI
53092-5537
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-1075
  • Fax: 262-375-4975
Mailing address:
  • Phone: 262-375-1075
  • Fax: 262-375-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6273-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: