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General NPI Number Information
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NPI Number | 1386169605
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Entity Type | Individual
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Provider Name | NICOLE MARIE WILKINSON DPT
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Gender | Female
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 4311 NORFOLK PKWY STE 116
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-8617
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Country | US
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Telephone | 321-802-5816
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Fax | 321-802-5811
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Provider Business Mailing Address
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Address Line | 2909 N 118TH ST STE 200
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City | OMAHA
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State | NE
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Zip | 68164-3643
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Country | US
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Telephone | 402-509-5532
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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 | PT35179
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License Number State | FL
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