Provider Demographics
NPI:1144632787
Name:WILKINSON, DAVID (LMT, CMT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 15TH AVE. S.E.
Mailing Address - Street 2:APARTMENT D
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322
Mailing Address - Country:US
Mailing Address - Phone:760-567-9107
Mailing Address - Fax:
Practice Address - Street 1:317 1ST AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2225
Practice Address - Country:US
Practice Address - Phone:541-905-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19883172M00000X
CA9196172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist