Provider Demographics
NPI:1730260621
Name:WILKES, LAUREN M (PT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:WILKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:MCNAMEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:412 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:MILMONT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19033-3300
Mailing Address - Country:US
Mailing Address - Phone:610-583-1133
Mailing Address - Fax:610-583-0855
Practice Address - Street 1:412 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:MILMONT PARK
Practice Address - State:PA
Practice Address - Zip Code:19033-3300
Practice Address - Country:US
Practice Address - Phone:610-583-1133
Practice Address - Fax:610-583-0855
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10002002225100000X
PAPT017756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist