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General NPI Number Information
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NPI Number | 1427520196
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Entity Type | Individual
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Provider Name | CAROL LYNN WILKIN PT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 630 KENMOOR AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546
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Country | US
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Telephone | 616-975-6200
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Fax | 617-975-5540
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Provider Business Mailing Address
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Address Line | 823 ARDMORE ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-2706
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Country | US
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Telephone | 616-452-2839
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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 | 5501000885
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License Number State | MI
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