Provider Demographics
NPI:1356637094
Name:WILKISON, BRIDGETTE MARIE (LMT, NCBTMB)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:MARIE
Last Name:WILKISON
Suffix:
Gender:F
Credentials:LMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NE ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7551
Mailing Address - Country:US
Mailing Address - Phone:503-490-3334
Mailing Address - Fax:
Practice Address - Street 1:101 NE ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7551
Practice Address - Country:US
Practice Address - Phone:503-490-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18186172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist