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NPI 1962048637

NPI 1962048637 : JESSICA MARY WILKES DPT : FALLS CHURCH, VA

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General NPI Number Information
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    NPI Number           |    1962048637
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    Entity Type          |    Individual 
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    Provider Name        |    JESSICA MARY WILKES DPT
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    11/18/2019
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    Last Update Date     |    08/15/2025
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Provider Practice Location Address
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    Address Line         |    510 S WASHINGTON ST STE A 
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    City                 |    FALLS CHURCH
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    State                |    VA
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    Zip                  |    22046-4415
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    Country              |    US
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    Telephone            |    703-992-7255
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    2122 YORK RD STE 300 
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    City                 |    OAK BROOK
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    State                |    IL
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    Zip                  |    60523-1925
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    Country              |    US
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    Telephone            |    
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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       |    PT-5243-0
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    License Number State |    HI
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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       |    303968
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    License Number State |    CA
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Taxonomy #3
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    Taxonomy Code        |    225100000X
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    Taxonomy Name        |    Physical Therapist
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    License Number       |    2305212349
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    License Number State |    VA
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