Provider Demographics
NPI:1225008634
Name:WILKINS, SCOTT ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANTHONY
Last Name:WILKINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 DAHLBERG DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4841
Mailing Address - Country:US
Mailing Address - Phone:952-847-4029
Mailing Address - Fax:
Practice Address - Street 1:820 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-4912
Practice Address - Country:US
Practice Address - Phone:952-442-2160
Practice Address - Fax:952-442-2961
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1880PT225100000X
MN8071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11B07WIOtherBLUE CROSS BLUE SHIELD OF MN
MN11B07WIOtherBLUE CROSS BLUE SHIELD OF MN