Provider Demographics
NPI:1366501686
Name:WILKIE, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WILKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 TALMADGE ST
Mailing Address - Street 2:#2
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5453
Mailing Address - Country:US
Mailing Address - Phone:608-204-7072
Mailing Address - Fax:
Practice Address - Street 1:150 TALMADGE ST
Practice Address - Street 2:#2
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5453
Practice Address - Country:US
Practice Address - Phone:608-204-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10515-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist