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General NPI Number Information
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NPI Number | 1336542372
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE WILKENS PT
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Gender | Female
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Dates
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Enumeration Date | 10/05/2014
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Last Update Date | 10/05/2014
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Provider Practice Location Address
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Address Line | 701 DELLWOOD ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1920
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Country | US
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Telephone | 612-262-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 DUPONT AVE S APT 106
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2707
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Country | US
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Telephone | 563-570-4410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9839
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1819
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License Number State | ND
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