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General NPI Number Information
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NPI Number | 1811613367
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Entity Type | Individual
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Provider Name | KEILYN WILKERSON PTA
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 395 VILLAGE DRIVE
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City | KISSIMMEE
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State | FL
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Zip | 34759
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Country | US
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Telephone | 407-914-9168
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Fax | 407-337-8005
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Provider Business Mailing Address
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Address Line | 2717 EAGLE CANYON DRIVE SOUTH
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City | KISSIMMEE
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State | FL
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Zip | 34746
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Country | US
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Telephone | 919-606-6423
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Fax | 407-337-8005
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA32379
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License Number State | FL
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