Provider Demographics
NPI:1013224997
Name:WILCOX, ASHLEY (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 LOWER HONOAPIILANI RD
Mailing Address - Street 2:110
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-9246
Mailing Address - Country:US
Mailing Address - Phone:808-669-0078
Mailing Address - Fax:808-669-0178
Practice Address - Street 1:4310 LOWER HONOAPIILANI RD STE 110
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-9204
Practice Address - Country:US
Practice Address - Phone:808-669-0078
Practice Address - Fax:808-669-0178
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21428225100000X
HI3220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist