Provider Demographics
NPI:1083982375
Name:WILKES, KIMBERLY U (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:U
Last Name:WILKES
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 1:8925 WEST RUSSELL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1220
Mailing Address - Country:US
Mailing Address - Phone:702-914-6787
Mailing Address - Fax:702-914-6885
Practice Address - Street 1:8925 W RUSSELL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1219
Practice Address - Country:US
Practice Address - Phone:702-914-6787
Practice Address - Fax:702-914-6885
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist