Provider Demographics
NPI:1417272980
Name:WILKINSON, JULIE CRYSTAL
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CRYSTAL
Last Name:WILKINSON
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 1:18206 CORY RD
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-2712
Mailing Address - Country:US
Mailing Address - Phone:985-320-7214
Mailing Address - Fax:
Practice Address - Street 1:18206 CORY RD
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-2712
Practice Address - Country:US
Practice Address - Phone:985-320-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2010-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3562225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist