1336361088 NPI number — MRS. CYNTHIA CLARK WILKINSON P.T.

Table of content: MRS. CYNTHIA CLARK WILKINSON P.T. (NPI 1336361088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336361088 NPI number — MRS. CYNTHIA CLARK WILKINSON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKINSON
Provider First Name:
CYNTHIA
Provider Middle Name:
CLARK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336361088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 FOLLY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUMPASS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23024-2526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-556-4711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23093-6563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-967-1757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305006337 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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