Provider Demographics
NPI:1225278112
Name:WILCOX, JEANNETTE ELISE (CMT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:ELISE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 VISTA ORO
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-8365
Mailing Address - Country:US
Mailing Address - Phone:760-779-5105
Mailing Address - Fax:
Practice Address - Street 1:79440 HIGHWAY 111
Practice Address - Street 2:SUITE 104
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4500
Practice Address - Country:US
Practice Address - Phone:760-771-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist