Provider Demographics
NPI:1588250005
Name:LEGROS, WILKELLY (LMT, MA)
Entity type:Individual
Prefix:MR
First Name:WILKELLY
Middle Name:
Last Name:LEGROS
Suffix:
Gender:M
Credentials:LMT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 VINEYARD LN
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:DE
Mailing Address - Zip Code:19943-5579
Mailing Address - Country:US
Mailing Address - Phone:302-505-6781
Mailing Address - Fax:
Practice Address - Street 1:179 VINEYARD LN
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:DE
Practice Address - Zip Code:19943-5579
Practice Address - Country:US
Practice Address - Phone:302-505-6781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0015096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty