Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 14983 | NC |
NPI | 1003221920 |
---|---|
Provider Name | Kristi Wilkins |
First Address | Fayetteville, NC 28304-7294 |
Second Address | Fayetteville, NC 28304-4450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 07/10/2015 |