Provider Demographics
NPI:1659302487
Name:WILHELMS, GREGORY L (PT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:WILHELMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 ACADEMY PL
Mailing Address - Street 2:SUITE 50
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1696
Mailing Address - Country:US
Mailing Address - Phone:719-475-0808
Mailing Address - Fax:719-475-8822
Practice Address - Street 1:1604 E PIKES PEAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5619
Practice Address - Country:US
Practice Address - Phone:719-630-3193
Practice Address - Fax:719-630-3195
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO306143Medicare PIN