Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1085033 | TX |
NPI | 1356823991 |
---|---|
Provider Name | Mrs. Lourdes Raquel Wilkerson |
First Address | Wills Point, TX 75169-3120 |
Second Address | Wills Point, TX 75169-3120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |