Provider Demographics
NPI:1336317684
Name:WILKINS, STEPHEN JASON (DPT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JASON
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 1:5065 HOLLYWOOD BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6122
Mailing Address - Country:US
Mailing Address - Phone:323-665-7675
Mailing Address - Fax:323-665-7226
Practice Address - Street 1:5065 HOLLYWOOD BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6122
Practice Address - Country:US
Practice Address - Phone:323-665-7675
Practice Address - Fax:323-665-7226
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT33100AMedicare PIN