Provider Demographics
NPI:1346559663
Name:WILKINS, NICHOLAS R (DPT)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:R
Last Name:WILKINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:5920 NE RAY CIR
Practice Address - Street 2:SUITE 160
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6429
Practice Address - Country:US
Practice Address - Phone:503-844-9294
Practice Address - Fax:503-615-0212
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500652986Medicaid
ORR168491Medicare PIN