Provider Demographics
NPI:1497060388
Name:WILCOX, MATTHEW D (PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:WILCOX
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:2243 S MERIDIAN AVE
Practice Address - Street 2:STE 105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-1949
Practice Address - Country:US
Practice Address - Phone:316-942-5448
Practice Address - Fax:316-945-5694
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS14-01222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist