Provider Demographics
NPI:1417521436
Name:WILKINS, MICHAEL C (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:WILKINS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:703-242-6460
Mailing Address - Fax:703-242-6463
Practice Address - Street 1:2960 CHAIN BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-3040
Practice Address - Country:US
Practice Address - Phone:703-242-6460
Practice Address - Fax:703-242-6463
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305214359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist