MEDICARE: MAKENZIE BLAIR WILKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P23184	NC

General Provider Information

NPI Number	:	1255188223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENZIE BLAIR WILKINS

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	570-550-0168
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	3708 FORESTVIEW RD STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2391
Country	:	US
Telephone Number	:	919-786-7434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	01/12/2026

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Directions to “ MAKENZIE BLAIR WILKINS ” Practice Location

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